Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.

BACKGROUND: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of pos...

Full description

Bibliographic Details
Main Authors: James W M Kigera, Masja Straetemans, Simplice K Vuhaka, Ingeborg M Nagel, Edward K Naddumba, Kimberly Boer
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2012-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC3414529?pdf=render
id doaj-772258facb704b2582f8a723d03e7d0f
record_format Article
spelling doaj-772258facb704b2582f8a723d03e7d0f2020-11-25T01:46:18ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0178e4225410.1371/journal.pone.0042254Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.James W M KigeraMasja StraetemansSimplice K VuhakaIngeborg M NagelEdward K NaddumbaKimberly BoerBACKGROUND: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours. METHODS: We searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method. RESULTS: We identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3-2.4), in studies in Africa this was 2.3 (95% CI 1.5-3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5-3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1-4.2). CONCLUSIONS: The results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infection.http://europepmc.org/articles/PMC3414529?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author James W M Kigera
Masja Straetemans
Simplice K Vuhaka
Ingeborg M Nagel
Edward K Naddumba
Kimberly Boer
spellingShingle James W M Kigera
Masja Straetemans
Simplice K Vuhaka
Ingeborg M Nagel
Edward K Naddumba
Kimberly Boer
Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
PLoS ONE
author_facet James W M Kigera
Masja Straetemans
Simplice K Vuhaka
Ingeborg M Nagel
Edward K Naddumba
Kimberly Boer
author_sort James W M Kigera
title Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
title_short Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
title_full Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
title_fullStr Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
title_full_unstemmed Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis.
title_sort is there an increased risk of post-operative surgical site infection after orthopaedic surgery in hiv patients? a systematic review and meta-analysis.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2012-01-01
description BACKGROUND: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and sought to determine if this risk is altered by antibiotic use beyond 24 hours. METHODS: We searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method. RESULTS: We identified 18 cohort studies with 16 mainly small studies, addressing the subject. The pooled risk ratio of infection in the HIV patients when compared to non-HIV patients was 1.8 (95% Confidence Interval [CI] 1.3-2.4), in studies in Africa this was 2.3 (95% CI 1.5-3.5). In a sensitivity analysis the risk ratio was reduced to 1.4 (95% CI 0.5-3.8). The risk ratio of infection in patients receiving prolonged antibiotics compared to patients receiving antibiotics for up to 24 hours was 0.7 (95% CI 0.1-4.2). CONCLUSIONS: The results may indicate an increased risk in HIV infected patients but these results are not robust and inconclusive after conducting the sensitivity analysis removing poor quality studies. There is need for larger good quality studies to provide conclusive evidence. To better develop surgical protocols, further studies should determine the effect of reduced CD4 counts, viral load suppression and prolonged antibiotics on the risk for infection.
url http://europepmc.org/articles/PMC3414529?pdf=render
work_keys_str_mv AT jameswmkigera isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
AT masjastraetemans isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
AT simplicekvuhaka isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
AT ingeborgmnagel isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
AT edwardknaddumba isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
AT kimberlyboer isthereanincreasedriskofpostoperativesurgicalsiteinfectionafterorthopaedicsurgeryinhivpatientsasystematicreviewandmetaanalysis
_version_ 1725020400293773312