Department of Breast and Oncoplastic Surgery, Worthing Hospital, Worthing, West Sussex, United Kingdom.
Breast J. 2012 Jul-Aug;18(4):312-7. doi: 10.1111/j.1524-4741.2012.01248.x. Epub 2012 May 23.
To systematically analyze published randomized trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures. Trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgery were selected and analyzed to generate summated data (expressed as risk ratio [RR]) by using RevMan 5.0. Nine randomized controlled trials encompassing 3720 patients undergoing breast surgery were retrieved from the electronic databases. The antibiotics group comprised a total of 1857 patients and non-antibiotics group, 1863 patients. There was no heterogeneity [χ(2) = 7.61, d.f. = 7, p < 0.37; I(2) = 8%] amongst trials. Therefore, in the fixed-effects model (RR, 0.64; 95% CI, 0.50-0.83; z = 3.48; p < 0.0005), the use of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures was statistically significant in reducing the incidence of surgical site infection (SSI). Furthermore, in the fixed-effects model (RR, 1.30; 95% CI, 0.89-1.90; z = 1.37; p < 0.17), adverse reactions secondary to the use of prophylactic antibiotics was not statistically significant between the two groups. Preoperative prophylactic antibiotics significantly reduce the risk of SSI after breast surgical procedures. The risk of adverse reactions from prophylactic antibiotic administration is not significant in these patients. Therefore, preoperative prophylactic antibiotics in breast surgery patients may be routinely administered. Further research is required, however, on risk stratification for SSI, timing and duration of prophylaxis, and the need for prophylaxis in patients undergoing breast reconstruction versus no reconstruction.
系统分析了已发表的关于预防性术前抗生素在接受乳房手术的患者中的有效性的随机试验。选择并分析了关于预防性术前抗生素在接受乳房手术的患者中的有效性的试验，以使用 RevMan 5.0 生成汇总数据（表示为风险比 [RR]）。从电子数据库中检索到 9 项关于预防性术前抗生素在接受乳房手术的患者中的有效性的随机对照试验，共纳入 3720 例患者。抗生素组共有 1857 例患者，非抗生素组有 1863 例患者。试验之间无异质性 [χ(2) = 7.61，d.f. = 7，p < 0.37；I(2) = 8%]。因此，在固定效应模型（RR，0.64；95%CI，0.50-0.83；z = 3.48；p < 0.0005）中，预防性术前使用抗生素在接受乳房手术的患者中可显著降低手术部位感染（SSI）的发生率。此外，在固定效应模型（RR，1.30；95%CI，0.89-1.90；z = 1.37；p < 0.17）中，两组之间预防性抗生素使用的不良反应发生率无统计学意义。预防性术前使用抗生素可显著降低乳房手术后 SSI 的风险。预防性抗生素给药的不良反应风险在这些患者中并不显著。因此，预防性术前抗生素可常规用于乳房手术患者。然而，还需要进一步研究 SSI 的风险分层、预防的时机和持续时间，以及在接受乳房重建与未接受重建的患者中预防的必要性。
