AlBuhairan B, Hind D, Hutchinson A
Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
J Bone Joint Surg Br. 2008 Jul;90(7):915-9. doi: 10.1302/0301-620X.90B7.20498.
We reviewed systematically the published evidence on the effectiveness of antibiotic prophylaxis for the reduction of wound infection in patients undergoing total hip and total knee replacement. Publications were identified using the Cochrane Library, MEDLINE, EMBASE and CINAHL databases. We also contacted authors to identify unpublished trials. We included randomised controlled trials which compared any prophylaxis with none, the administration of systemic antibiotics with that of those in cement, cephalosporins with glycopeptides, cephalosporins with penicillin-derivatives, and second-generation with first-generation cephalosporins. A total of 26 studies (11 343 participants) met the inclusion criteria. Methodological quality was variable. In a meta-analysis of seven studies (3065 participants) antibiotic prophylaxis reduced the absolute risk of wound infection by 8% and the relative risk by 81% compared with no prophylaxis (p < 0.00001). No other comparison showed a significant difference in clinical effect. Antibiotic prophylaxis should be routine in joint replacement but the choice of agent should be made on the basis of cost and local availability.
我们系统回顾了已发表的关于抗生素预防对全髋关节置换和全膝关节置换患者伤口感染减少效果的证据。通过Cochrane图书馆、MEDLINE、EMBASE和CINAHL数据库检索相关出版物。我们还联系了作者以识别未发表的试验。我们纳入了随机对照试验，这些试验比较了任何预防措施与无预防措施、全身使用抗生素与骨水泥中使用抗生素、头孢菌素与糖肽类、头孢菌素与青霉素衍生物，以及第二代头孢菌素与第一代头孢菌素。共有26项研究（11343名参与者）符合纳入标准。方法学质量参差不齐。在对7项研究（3065名参与者）的荟萃分析中，与不进行预防相比，抗生素预防使伤口感染的绝对风险降低了8%，相对风险降低了81%（p<0.00001）。其他比较均未显示临床效果有显著差异。抗生素预防在关节置换中应作为常规操作，但药物的选择应基于成本和当地可获得性。
