Optimal skin antiseptic agents for prevention of surgical site infection in cesarean section: a meta-analysis with trial sequential analysis

Purpose: The best choice of antiseptic agent for skin preparation at cesarean section remains controversial. We performed this meta-analysis to assess whether chlorhexidine (CH)-based skin antisepsis was more effective than povidone iodine (PI)-based antisepsis for the prevention of surgical site infection (SSI) after cesarean section.Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched to identify English publications that compared chlorhexidine gluconate (CH) as a skin preparation agent with PI in cesarean section. The primary outcome was SSI rate. Review Manager 5.3 was used to analyze the collected data and trial sequential analysis (TSA) Software 0.9 (Cochrane Collaboration, Oxford, UK) beta was applied to estimate whether the overall pooled outcome was conclusive.Results: Six articles involving 4385 participants were included in this study. The outcomes showed that CH-based skin antisepsis, compared with PI-based antisepsis, was not associated with a decreased overall rate of SSI (risk ratio [RR], 0.74; 95% confidence interval [CI], 0.54-1.02; p=.07). TSA indicated that the current available evidence was inconclusive. There were no differences in adverse skin reactions in the two groups.Conclusions: This study provides evidence that CH-based antisepsis for skin preparation does not show an additional advantage in reducing risk of SSI after cesarean section. However, additional high-quality, randomized clinical trials are needed to confirm these findings.