头孢曲松与其他抗生素用于手术预防：一项荟萃分析。

Ceftriaxone versus Other Antibiotics for Surgical Prophylaxis : A Meta-Analysis.

机构信息

Dipartimento di Medicina Pubblica Clinica e Preventiva - Sezione Malattie Infettive, Seconda Università degli Studi di Napoli, Naples, Italy.

出版信息

Clin Drug Investig. 2004;24(1):29-39. doi: 10.2165/00044011-200424010-00004.

DOI:10.2165/00044011-200424010-00004

PMID:17516688

Abstract

OBJECTIVE

To investigate possible differences in prophylaxis with ceftriaxone compared with other antimicrobial agents for surgical-site infections and remote infections such as respiratory tract infections (RTIs) and urinary tract infections (UTIs).

METHODS

The efficacy of ceftriaxone was compared with that of other antibiotics in the perioperative prophylaxis of local (surgical wound) and remote (RTIs and UTIs) infections in a meta-analysis of randomised controlled trials published between 1984 and 2003. The analysis was based on a 2 x 2 contingency table with classification by treatment and number of infections obtained from individual studies.

RESULTS

Evaluations were performed on 48 studies, for a total of 17 565 patients. Overall, 406 patients (4.8%) in the ceftriaxone group and 525 (6.3%) in the comparator group developed a surgical-site infection (log odds ratio [OR] -0.30 [CI -0.50 to -0.13]; p < 0.0001). RTIs were observed in 292 (6.01%) patients in the ceftriaxone group and in 369 (7.6%) patients in the comparator group, (log OR -0.30 [CI -0.55 to -0.09]; p = 0.0013). UTIs were reported for 2.2% of the ceftriaxone prophylaxis patients compared with 3.74% of the comparator group patients (log OR -0.54 [CI -1.18 to -0.16]; p < 0.0001). Overall, in clean surgery 195 (5.1%) and 234 (6.2%) patients developed a surgical site infection in the ceftriaxone and comparator groups, respectively (log OR -0.22 [CI -0.51 to 0.01]; p = 0.0476). RTIs were prevented for all but 1.57% of patients in the ceftriaxone group and 2.62% of patients in the comparator group (p = 0.01) in clean surgery, and for 9.54% of the ceftriaxone group versus 11.6% of the comparator group (p = 0.01) in clean-contaminated surgery. While results observed in clean surgery did not show statistically significant superiority of ceftriaxone in preventing UTI insurgence (log OR -0.21 [CI 0.0-0.65]; p = 0.7702), this was clearly shown in the clean-contaminated surgery. In fact, 4.47% of patients in the ceftriaxone group versus 7.52% of patients in the comparator group developed a UTI (log OR -0.56 [CI -1.25 to -0.16]; p < 0.0001). Adverse events were observed in a similar proportion in the ceftriaxone prophylaxis and the comparator groups (0.35% and 0.23%, respectively). Duration of prophylaxis did not influence outcome of infection.

CONCLUSIONS

The meta-analysis showed that ceftriaxone is statistically superior to other antibiotics in preventing both local and remote postoperative infections.

摘要

目的

研究头孢曲松与其他抗菌药物在预防手术部位感染和呼吸道感染（RTI）和尿路感染（UTI）等远处感染方面的差异。

方法

在 1984 年至 2003 年期间发表的随机对照试验的荟萃分析中，比较了头孢曲松与其他抗生素在局部（手术伤口）和远处（RTI 和 UTI）感染的围手术期预防中的疗效。该分析基于 2x2 列联表，通过来自各个研究的治疗和感染数量进行分类。

结果

对 48 项研究进行了评估，共有 17565 名患者。总体而言，头孢曲松组有 406 名（4.8%）患者和对照组有 525 名（6.3%）患者发生手术部位感染（对数优势比[OR] -0.30 [95%CI -0.50 至 -0.13]；p<0.0001）。头孢曲松组有 292 名（6.01%）患者发生 RTI，对照组有 369 名（7.6%）患者发生 RTI（对数 OR -0.30 [95%CI -0.55 至 -0.09]；p=0.0013）。头孢曲松预防组有 2.2%的患者发生 UTI，对照组有 3.74%的患者发生 UTI（对数 OR -0.54 [95%CI -1.18 至 -0.16]；p<0.0001）。在清洁手术中，头孢曲松组有 195 名（5.1%）患者和对照组有 234 名（6.2%）患者发生手术部位感染（对数 OR -0.22 [95%CI -0.51 至 0.01]；p=0.0476）。在清洁手术中，头孢曲松组除 1.57%的患者和对照组除 2.62%的患者（p=0.01）外，预防了所有 RTI，而在清洁污染手术中，头孢曲松组有 9.54%的患者和对照组有 11.6%的患者（p=0.01）预防了 RTI。虽然在清洁手术中观察到的结果并未显示头孢曲松在预防 UTI 方面具有统计学优势（对数 OR -0.21 [95%CI 0.0 至 0.65]；p=0.7702），但在清洁污染手术中则明显如此。事实上，头孢曲松组有 4.47%的患者发生 UTI，对照组有 7.52%的患者发生 UTI（对数 OR -0.56 [95%CI -1.25 至 -0.16]；p<0.0001）。头孢曲松预防组和对照组的不良反应发生率相似（分别为 0.35%和 0.23%）。预防时间并不影响感染结果。