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Question clinique
Do antibiotic delivery devices improve outcomes following surgery for foot infections in patients with diabetes?
L’Essentiel
We don't really know yet if antibiotic delivery devices improve outcomes in patients with diabetes who undergo surgery for foot infections because there is only one (limited-quality) randomized trial in the literature. 3a-
Référence
Plan de l'etude: Systematic review
Financement: Unknown/not stated
Cadre: Various (meta-analysis)
Sommaire
These authors searched MEDLINE and EMBASE to identify studies that evaluated implanted devices that locally delivered antibiotics to patients with diabetes who were undergoing surgery for foot infections. The authors also searched the reference lists of review articles, but did not search for unpublished studies. They included observational studies as long as the studies included more than 5 patients. Ultimately, the authors included 13 studies with 798 patients, only one of which was a randomized trial (50 patients). Ten studies assessed wound healing, 12 assessed repeat surgery, 5 assessed mortality, 3 assessed hospital length of stay, and 1 study was an economic analysis. Only 3 studies were clearly at low risk of bias and only 3 used a control group. Two of the studies had authors with potential conflicts of interest. The lone randomized trial was only of fair quality. The authors wisely chose to not pool the data. Although several studies reported healing rates, overall there was no improvement in healing rates, except in the randomized trial.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI