Anne Samantha, Ishman Stacey L, Schwartz Seth
Department of Otolaryngology-Head and Neck Surgery, The Cleveland Clinic, Cleveland, Ohio, USA
Divisions of Pediatric Otolaryngology-Head and Neck Surgery & Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Ann Otol Rhinol Laryngol. 2016 Nov;125(11):893-899. doi: 10.1177/0003489416660113. Epub 2016 Jul 21.
Previous Cochrane review of prophylactic antibiotic use in clean and clean-contaminated ear surgery showed no benefit; however, these studies did not address cochlear implant (CI) surgery specifically.
Systematically review effects of perioperative antibiotics on risk of infections and related complications in CI surgery SEARCH METHODS: PubMed, EMBASE, Medline, CINAHL, and Cochrane library were searched from inception to March 2015. Manual searches of bibliographies were also completed.
We included all studies that describe perioperative antibiotic use in CI surgery. Outcome measures included infection, meningitis, implant extrusion, and adverse antibiotics effects. Two independent evaluators reviewed each abstract and article.
One hundred and seventy-three studies were identified in search. Three met inclusion criteria and were reviewed. Articles were low quality; no randomized trials were identified. For included studies, numerous antibiotic types and dosing regimens were used. Recorded outcome measures were heterogeneous, and detailed information was frequently unavailable. Overall infection rate was low (3%-4.5%); single dose antibiotic prophylaxis showed low rate of complications (1%) in 2 studies.
There is insufficient evidence to make definitive conclusions about the role of perioperative antibiotics in CI surgery. Reported infection rates are low; however, decision to use antibiotics should be based on assessment of risks and benefits to each patient.
先前Cochrane关于清洁及清洁-污染耳部手术中预防性使用抗生素的综述显示并无益处；然而，这些研究并未专门针对人工耳蜗（CI）手术。
系统评价围手术期使用抗生素对CI手术感染风险及相关并发症的影响。
检索了PubMed、EMBASE、Medline、CINAHL和Cochrane图书馆，检索时间从建库至2015年3月。还完成了对参考文献的手工检索。
我们纳入了所有描述CI手术围手术期使用抗生素的研究。观察指标包括感染、脑膜炎、植入物外露及抗生素不良反应。两名独立评价者对每篇摘要和文章进行了评审。
检索到173项研究。3项符合纳入标准并进行了评审。文章质量较低；未检索到随机试验。对于纳入的研究，使用了多种抗生素类型和给药方案。记录的观察指标存在异质性，且常常无法获得详细信息。总体感染率较低（3%-4.5%）；两项研究中单次剂量抗生素预防显示并发症发生率较低（1%）。
关于围手术期使用抗生素在CI手术中的作用，尚无足够证据得出明确结论。报告的感染率较低；然而，是否使用抗生素的决定应基于对每位患者风险和益处的评估。
