Post-op antibiotic delivery devices do not improve healing after diabetic foot infections

Reference

Marson BA, Deshmukh SR, Grindlay DJC, Ollivere BJ, Scammell BE. A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics. Bone Joint J 2018;100-B(11):1409-1415.

Synopsis

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 The authors also searched the reference lists of review articles, but did not search for unpublished studies.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.