Department of Oral- and Maxillofacial Surgery, University Medical Center, Augustusplatz 2, 55131, Mainz, Germany.
Infection. 2019 Aug;47(4):519-555. doi: 10.1007/s15010-019-01303-8. Epub 2019 Apr 3.
Especially in oral and maxillofacial surgery, where procedures involving the aero-digestive tract considered clean contaminated, surgical site infections (SSI) represent a severe health care burden. To improve implementation and methodological standard, an upgrade of the existing S1 guideline to a consensus-guided S3 guideline was initiated by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF, register number 067/009) and 25 collaborating medical societies.
A systematic literature search based on the Scottish Intercollegiate GL Network (SIGN)-search string for the guideline "Antibiotic prophylaxis in surgery" from 2014 was performed and equivalent exclusion/inclusion criteria were applied. An additional hand search provided latest evidence.
In total, 80 clinical trials, retrospective studies, reviews, and meta-analysis were analyzed. For orthognathic surgery, prolonged antibiotic regimen may reduce risk for SSI but there is lack of evidence for the effects of short- vs. long-term therapy. For maxillofacial traumatology, antibiotic prophylaxis might reduce SSI but prolonged postoperative dosing shows no benefit. For clean-contaminated oncological interventions, anti-infectious therapy for 24 h only can reduce SSI; patients may not benefit from prolonged regimen. In contrast, for dentoalveolar procedures such as implantology or third molar removal, literature reveals ambivalent results.
In summary, consensus process of the planned S3 guideline is much in need to transfer the indecisive results for antibiotic prophylaxis in dentoalveolar surgery in clinical praxis and encourage adherence to guidelines.
特别是在口腔颌面外科，涉及气消化道的手术被认为是清洁污染的，手术部位感染（SSI）是严重的医疗负担。为了提高实施和方法学标准，由德国科学医学协会联合会（Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.，AWMF）和 25 个合作医学协会发起了一项将现有的 S1 指南升级为共识指导的 S3 指南的项目。
根据苏格兰校际综合指南网络（Scottish Intercollegiate GL Network，SIGN）-2014 年“手术抗生素预防”指南的搜索字符串进行了系统的文献搜索，并应用了等效的排除/纳入标准。此外，还进行了额外的手工搜索以提供最新的证据。
总共分析了 80 项临床试验、回顾性研究、综述和荟萃分析。对于正颌手术，延长抗生素疗程可能降低 SSI 的风险，但短期与长期治疗的效果缺乏证据。对于口腔颌面创伤学，抗生素预防可能降低 SSI，但延长术后给药没有益处。对于清洁污染的肿瘤学干预，仅 24 小时的抗感染治疗可以降低 SSI；患者可能不会从延长疗程中受益。相比之下，对于牙种植体或第三磨牙拔除等牙牙槽手术，文献结果存在矛盾。
总之，计划中的 S3 指南的共识过程非常需要将牙牙槽手术中抗生素预防的不确定结果转化为临床实践，并鼓励遵守指南。
