Reply to the Letter to the Editor: Can Topical Vancomycin Prevent Periprosthetic Joint Infection in Hip and Knee Arthroplasty? A Systematic Review
Notice bibliographique
Résumé
To the Editor, We thank Drs. Pijls and Nelissen for their comments and analysis related to our article entitled “Can Topical Vancomycin Prevent Periprosthetic Joint Infection in Hip and Knee Arthroplasty? A Systematic Review” [2]. Their interpretations and experiences are valuable contributions to this important and often challenging topic of periprosthetic joint infection (PJI). We appreciate that Drs. Pijls and Nelissen raised the concept of “vote counting,” which, as they stated in their letter, should be avoided when performing systematic reviews [1]. We acknowledge that this method has limitations and may lead to inaccurate conclusions. However, we would assert that we did not perform vote counting in our study as alleged by Drs. Pijls and Nelissen in their letter. We presented the results and indicated which ones (and how many) identified an advantage associated with vancomycin; the fact that most studies did not was not the key finding. The key finding was how broadly most of those studies’ findings bracketed the line of no-difference. Such consistently wide 95% CIs across so many studies, in this situation, is the key finding, not the number of studies that found a “significant difference.” We refrained from performing a meta-analysis as part of our study because data pooling (meta-analysis) of nonrandomized studies is considered poor meta-analytic practice, as the kinds of biases likely present in studies of that design typically will overstate the apparent benefits of the treatment being studied. Instead, as is appropriate for the kinds of studies we analyzed, we performed a systematic review of the best-available evidence. We also agree that the fact that a study does not identify a statistical difference does not necessarily mean that an effect is absent. Most of the studies included in our review were likely underpowered to demonstrate statistical differences. However, to justify a treatment that has risks, such as vancomycin powder, it seems important to have high-quality studies demonstrating an advantage to doing so. Our systematic review found insufficient evidence at this time to recommend the routine use of topical vancomycin powder for PJI prophylaxis. Adequately powered randomized controlled trials are needed. Furthermore, the random effects model done by Drs. Pijls and Nelissen shows a number needed to treat of approximately 145 in favor of topical vancomycin powder. The authors raise the question: “Do we want to expose 145 patients to possibly reduce one occurrence of PJI considering that we do not know the safety concerns associated with vancomycin and we could possibly introduce antimicrobial resistance, which makes treatment of PJI cases more difficult or even impossible in the future?” While those are valid concerns, we feel that the best way to answer these questions is through a methodologically sound randomized controlled trial.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,022 | 0,147 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,003 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,004 | 0,006 |
| Science ouverte | 0,005 | 0,002 |
| Intégrité de la recherche | 0,024 | 0,027 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».