Antibiotics impregnated calcium sulfate (AI-CaSO4) is an innovative practice to ensure local diffusion of antibiotics especially in the treatment of prosthesis or medical implants infections. A recent introduction of AI-CaSO4 at CHU de Québec-Université Laval (CHU de Québec) was followed by a rapid increase in use and costs. A hospital-based health technology assessment (HTA) was then requested to assess the clinical relevance of AI-CaSO4 in surgical site infection (SSI) management.

A systematic review of the effectiveness and adverse effects of AI-CaSO4 was performed in indexed databases and grey literature. The local context analysis included different methodologies: 1) interviews with pharmacists, surgeons and operating room managers, 2) data extraction from electronic patient records (EPR), 3) procurement database on CaSO4, and 4) interdisciplinary working group including orthopedic and vascular surgeons, pharmacists, infectiologists, and hospital managers.

Available evidence suggest that AI-CaSO4 could contribute in the treatment of osteomyelitis whereas no conclusion can be drawn for other medical indications in both treatment and prevention of SSI. A review of 113 surgical procedures showed that AI-CaSO4 was rapidly adopted after only one year and used for various medical indications in neuromodulation, orthopedic and vascular surgery. Osteomyelitis treatment accounted for less than 3% of cases. AI-CaSO4 was mainly used in prevention of SSI (65%) and surgical revisions (74%). Furthermore, local safety issues were raised by a lack of standardization for the preparation and under recording of antibiotics use with AI-CaSO4.

The current state of knowledge does not support the widespread use AI-CaSO4 at CHU de Québec. This study highlights the importance of adapting HTA approach to the local context to influence decision-making especially in the context of innovating practice in order to insure the relevance, safety and sustainability of care.