Is There an Increased Risk of Post-Operative Surgical Site Infection after Orthopaedic Surgery in HIV Patients? A Systematic Review and Meta-Analysis

Abstract

BackgroundThere 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.MethodsWe searched electronic databases, manually searched citations from relevant articles, and reviewed conference proceedings. The risk of postoperative SSI was pooled using Mantel-Haenszel method.ResultsWe 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).ConclusionsThe 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.

Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania

“…Failure of the immune system in HIV infected patients increase the possibility of developing surgical site infections post operatively 17, 18 ,19 . In the current study HIV infection was not statistically significantly associated with development of SSI as similar as it was documented by other surveyors (20,21) reflecting HIV per se not to be a major risk factor for SSI development in orthopaedic practice. However, this observation might be due to small sample size analysed in these studies.…”

Orthopaedic trauma surgery in low-income countries

“…82 However, they did not use systemic prophylactic antibiotics before surgery, and if all Hiv positive patients were combined in one group no significant difference in infection rate was seen. A recent meta-analysis did suggest that there might be more postoperative infections in Hiv positive patients, 83 but the findings were based on many old and small studies and were not conclusive. infection does seem to be more common in Hiv-positive patients after open fractures, 84 but the increased risk is probably more influenced by the severity of the injury 85 and contamination of the wound, 86 or with the life style of the patients.…”

Reporte de un caso: Fractura expuesta del mediopie por accidente de tránsito en paciente VIH/SIDA

“…En las especialidades quirúrgicas, el servicio de cirugía general presenta un mayor número de exposiciones a VIH (17,5%), seguido de traumatología (14,6%). medicina interna presenta el 15% (7) .…”