Which antiseptic to use for a Caesarean section? A systematic review and network meta-analysis of randomised controlled trials.

BACKGROUND

Guidelines for preoperative skin antisepsis recommend using chlorhexidine in an alcohol-based solution. However, other antiseptics such as aqueous povidone iodine or alcohol-based solutions are still used. Randomised controlled trials (RCTs) in Caesarean section (CS) are rare and do not include all possible comparisons of antiseptics.

AIM

To assess the efficacy (reduction of surgical site infections) of chlorhexidine at two different concentrations (0.3% and 2%) and povidone iodine in aqueous or alcohol-based solutions using a network meta-analysis, including only RCTs of caesarean sections. Fragility indexes and prediction intervals were also estimated.

METHODS

A systematic literature review and network meta-analysis (NMA) were performed. RCTs published up to February 2024 were collected from PubMed, ScienceDirect and the Cochrane Library. Interventions included alcohol-based povidone iodine; aqueous povidone iodine; alcohol-based chlorhexidine 2% and 0.3%. The primary outcome measure was surgical site infection.

RESULTS

Nine RCTs with 4915 patients and 4 interventions were included in the NMA. All credible intervals of the compared interventions overlapped. Alcohol-based 2% chlorhexidine had the highest probability of being effective in preventing surgical site infections, followed by alcohol-based povidone iodine. The fragility index ranged from 4 to 18. The prediction intervals were wide.

CONCLUSIONS

On the basis of rank probabilities, chlorhexidine 2% in an alcohol-based solution was most likely to be effective in preventing surgical site infections after CS, followed by alcohol-based povidone-iodine. Given the paucity of literature and the relatively small difference between povidone-iodine and chlorhexidine found in our meta-analysis, we suggest that either can be used in an alcohol-based solution as antisepsis for planned or emergency CS.

Informations de copyright

Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None.