Intrawound vancomycin for prevention of surgical site infection: meta-analysis of randomized clinical trials
In brief
Intrawound vancomycin cuts overall surgical site infections by 21%
A meta-analysis of 22 randomized trials involving 8,424 adults found that applying vancomycin directly to the wound lowered the overall infection rate from standard care (about one fewer infection per 82 patients treated) and halved Gram-positive infections. The benefit was modest, did not affect deep or superficial infections, and evidence quality was moderate, suggesting selective rather than routine use.
- Journal
- BJS open (Q1)
- Published
- 4 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Shaan Patel, Shiva A Nischal, Kush M Kale, Angelette Mendonca, Nelson Sofoluke, Srinivas K Prasad, et al.
- PMID
- 42765564
- DOI
- 10.1093/bjsopen/zrag131
Why clinicians should know about it
- Picked for Surgery (paper of the day, 23 September 2026): Intrawound vancomycin meta‑analysis for SSI reduction
Abstract
BACKGROUND: Surgical site infection remains a major cause of postoperative morbidity. Intrawound vancomycin has been proposed as an adjunct to standard prophylaxis, but its effectiveness across surgical settings remains uncertain. This systematic review and meta-analysis of randomized clinical trials aimed to evaluate the association between intraoperative intrawound vancomycin and surgical site infection in adults undergoing surgery. METHODS: MEDLINE, Embase, and CENTRAL were searched from database inception to March 2026 for randomized clinical trials comparing intrawound vancomycin with standard care in adults undergoing operative procedures. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses were undertaken, with certainty of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were overall surgical site infection, deep surgical site infection, superficial surgical site infection, and Gram-positive surgical site infection. RESULTS: Twenty-two trials enrolling 8424 patients (vancomycin 4228, control 4196) were included. Intrawound vancomycin was associated with a lower risk of overall surgical site infection (risk ratio 0.79, 95% confidence interval 0.64 to 0.99) and Gram-positive surgical site infection (risk ratio 0.53, 0.35 to 0.79), corresponding to numbers needed to treat of 82 and 78, respectively. No significant differences were observed for deep or superficial surgical site infection, Gram-negative infection, reoperation, wound complications, mortality, or length of hospital stay. The certainty of evidence was moderate. CONCLUSION: Intrawound vancomycin was associated with a modest reduction in surgical site infection, driven by reductions in Gram-positive infections. These findings support a selective, context-specific use rather than routine application across all procedures.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.