Shapiro M
Department of Clinical Microbiology, Hadassah University Hospital, Jerusalem, Israel.
Rev Infect Dis. 1991 Sep-Oct;13 Suppl 10:S858-68. doi: 10.1093/clinids/13.supplement_10.s858.
In an assessment of prospective, controlled studies of antimicrobial prophylaxis against infections following otolaryngologic surgery and neurosurgery, the English-language literature on this topic was reviewed. Rates of infection following clean otolaryngologic operations are the same for patients receiving prophylaxis and those receiving placebo. For patients with head and neck cancer, rates of postoperative infection without antibiotic prophylaxis in clean surgery are less than 1%, and prophylaxis is not indicated; in contrast, in clean-contaminated procedures (infection rate, 18%-87%), prophylaxis is highly protective, although several studies have shown no advantage to its prolongation beyond 24 hours. For the latter operations, drugs with adequate activity against oral anaerobes are essential, whereas the need for coverage against Enterobacteriaceae is doubtful. In clean and clean-contaminated neurosurgical procedures, the rate of protective efficacy of prophylaxis ranges between 63% and 76%. For shunt operations the available evidence favors prophylaxis, but the wide range of infections reported mandates a large-scale multicenter trial to decide the issue.
在一项针对耳鼻喉科手术和神经外科手术后抗菌预防感染的前瞻性对照研究评估中，对该主题的英文文献进行了综述。接受预防治疗的患者和接受安慰剂的患者在清洁耳鼻喉科手术后的感染率相同。对于头颈癌患者，清洁手术中未使用抗生素预防的术后感染率低于1%，无需进行预防；相比之下，在清洁-污染手术中（感染率为18%-87%），预防具有高度保护作用，尽管多项研究表明，预防时间超过24小时并无益处。对于后一种手术，对口腔厌氧菌有足够活性的药物至关重要，而针对肠杆菌科的覆盖需求则值得怀疑。在清洁和清洁-污染神经外科手术中，预防的保护有效率在63%至76%之间。对于分流手术，现有证据支持进行预防，但报告的感染范围广泛，需要进行大规模多中心试验来确定这一问题。
