Background/Objectives: To evaluate the effectiveness of local antibiotic prophylaxis (e.g., powder, bone cement, intraosseous injection) in reducing periprosthetic joint infections (PJI) and deep wound infections in adults undergoing primary joint replacement surgery. Methods: A comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted from inception to 7 September 2024, including randomized controlled trials (RCTs) and cohort studies without language restrictions. Quality assessment was performed using the Cochrane Risk of Bias (RoB) 2.0 for RCTs and the Newcastle–Ottawa Scale (NOS) for cohort studies. Infection rates were extracted and analyzed using risk ratios (RR) or odds ratios (OR) in a random-effects model with Review Manager (RevMan) 5.4. Sensitivity analysis and meta-regression were also performed to validate the study results and possible risk factors. Results: Twelve RCTs and 21 cohort studies were included in the review. Vancomycin powder in the cohort studies demonstrated statistical significance (OR = 0.47, 95% confidence interval (CI): 0.36–0.61, I² = 0%), in contrast to the results in the RCTs (RR = 0.37, 95% CI: 0.06–2.47, I² = 49%). Sensitivity analyses confirmed the robustness and statistical significance of these findings. Both the control and treatment groups primarily cultured Gram-positive pathogens, including in the overall data and specifically for vancomycin powder. The evidence for the use of intraosseous injection (RR of RCTs not estimable, I² not applicable; OR of cohorts = 0.12, 95% CI: 0.02–0.63, I² = 0%) and bone cement (RR of RCTs = 0.40, 95% CI: 0.14–1.17, I² = 56%; OR of cohorts = 1.88, 95% CI: 1.25–2.82, I² not applicable) was inconclusive. Smoking was identified as an important risk factor for post-operative infection. Further research, including more robust trials and cohort studies, is needed to confirm these findings. Conclusions: Local administration of vancomycin powder appears effective in preventing deep wound infection after arthroplasty.

To evaluate the effectiveness and safety of different antibiotic regimens for multidrug-resistant Acinetobacter baumannii (MDRAB) pneumonia using a network meta-analysis (NMA). PubMed, Embase, and the Cochrane Library were searched from inception to January 2026. Randomized controlled trials and cohort studies were eligible for the systematic review; only cohort studies with MDRAB pneumonia and a connected treatment network were included in the NMA. The review was registered in PROSPERO (CRD42023481794). Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 for randomized trials and the Newcastle-Ottawa Scale for observational studies. A frequentist random-effects NMA estimated odds ratios (ORs) with 95% confidence intervals and P-scores for treatment ranking. Short-term mortality, clinical response, microbiological eradication, nephrotoxicity, and neurotoxicity were analysed. Seventeen cohort studies including 1420 patients were synthesized. Colistin-based inhalation regimens ranked highest for clinical response, whereas tigecycline-based regimens were consistently less favorable. Sulbactam-based and colistin-based regimens showed similar effectiveness for clinical response and microbiological eradication. Overall, no statistically significant differences in mortality were observed between sulbactam-based and colistin-based regimens; however, the colistin-sulbactam combination regimen showed a tendency toward higher mortality than other colistin-based regimens. Similarly, the results for nephrotoxicity were comparable among the different regimens. Sulbactam-based regimens appear to offer effectiveness comparable to colistin-based regimens for MDRAB pneumonia, while tigecycline-based regimens may require higher doses to achieve optimal benefit. These findings can inform regimen selection where newer agents are unavailable.