Barker Fred G
Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts, USA.
Neurosurgery. 2002 Aug;51(2):391-400; discussion 400-1.
There is considerable variation in practice regarding the use of prophylactic antibiotic therapy in spinal operations. To date, individual studies have not demonstrated a significant benefit for prophylactic antibiotic therapy in spinal operations.
Systematic database searches for randomized prospective trials of prophylactic antibiotic therapy in spinal surgery, general neurosurgery, and orthopedic surgery were performed. Random-effects meta-analysis and Bayesian meta-regressions of treatment benefits versus baseline infection rates and other trial characteristics were performed.
Six prospective randomized trials or trial subgroups, enrolling 843 patients, were identified, i.e., one spinal surgery trial, four general neurosurgery trials, and one general orthopedic surgery trial. No individual trial demonstrated a statistically significant effect of prophylactic antibiotic therapy for spinal surgery patients. Raw pooled infection rates were 2.2% (10 of 451 patients) with antibiotics and 5.9% (23 of 392 patients) without antibiotics. Individual trial infection rates ranged from 1.2 to 8.5%. The pooled odds ratio was 0.37 (95% confidence interval, 0.17-0.78), favoring antibiotic treatment (P < 0.01). There was no significant heterogeneity in treatment efficacy among the trials. Bayesian meta-regression was used to test whether antibiotics were less effective in trials with low baseline infection rates and whether an optimal antibiotic regimen could be identified. There was no significant difference in antibiotic treatment effects in trials with lower baseline infection rates, in trials using antibiotics with gram-negative coverage in addition to gram-positive coverage, or in trials using multiple-dose versus single-dose regimens. Nonrandomized studies of antibiotic therapy in spinal surgery yielded greater treatment effect estimates than did randomized trials, but not significantly so.
Prophylactic antibiotic therapy is beneficial for spinal surgery, even when expected infection rates without antibiotic treatment are low.
脊柱手术中预防性抗生素治疗的应用在实际操作中有很大差异。迄今为止，个别研究尚未证明预防性抗生素治疗在脊柱手术中有显著益处。
对脊柱手术、普通神经外科手术和骨科手术中预防性抗生素治疗的随机前瞻性试验进行系统的数据库检索。对治疗益处与基线感染率及其他试验特征进行随机效应荟萃分析和贝叶斯元回归分析。
共确定了6项前瞻性随机试验或试验亚组，纳入843例患者，即1项脊柱手术试验、4项普通神经外科手术试验和1项普通骨科手术试验。没有一项单独试验显示预防性抗生素治疗对脊柱手术患者有统计学显著效果。使用抗生素时的原始合并感染率为2.2%（451例患者中的10例），未使用抗生素时为5.9%（392例患者中的23例）。个别试验的感染率在1.2%至8.5%之间。合并优势比为0.37（95%置信区间，0.17 - 0.78），支持抗生素治疗（P < 0.01）。各试验间治疗效果无显著异质性。采用贝叶斯元回归分析来检验在基线感染率较低的试验中抗生素是否效果较差，以及是否能确定最佳抗生素方案。在基线感染率较低的试验、使用除革兰氏阳性菌覆盖外还具有革兰氏阴性菌覆盖的抗生素的试验，或使用多剂量与单剂量方案的试验中，抗生素治疗效果无显著差异。脊柱手术中抗生素治疗的非随机研究得出的治疗效果估计值比随机试验更大，但差异不显著。
预防性抗生素治疗对脊柱手术有益，即使在未进行抗生素治疗时预期感染率较低的情况下也是如此。
