Department of Surgery, Monash Health, Melbourne, Victoria, Australia.
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2021 Jul;91(7-8):1397-1404. doi: 10.1111/ans.16615. Epub 2021 Feb 12.
Appendicitis is the most frequent aetiology of acute abdominal pain requiring surgical treatment, with an estimated lifetime risk between 7% and 8%. Antibiotics play a substantial role in treatment, and there is considerable debate regarding the duration of antibiotics in treating appendicitis.
We searched multiple databases from inception until June 2019 for peer-reviewed studies that compared different durations of antibiotic treatment after appendicectomy for acute complicated appendicitis in adults. We dichotomized reported data into short- and extended-term antibiotic use and controlled for different definitional thresholds in the meta-analysis. We generated risk ratios using restricted maximum likelihood methods and mixed effects modelling for each outcome of interest.
Four observational studies involving 847 participants were included in the meta-analysis. For the primary outcomes of intra-abdominal infection, we did not find a statistically significant difference between extended- and short-term antibiotic strategies for intra-abdominal infection (Risk ratio 0.92, 95% confidence interval (CI) 0.49-1.74). Three randomized controlled trials involving 291 participants were included in a separate meta-analysis. We found that extended antibiotic usage was not associated with a statistically significant reduced risk for intra-abdominal infection (RR 0.52, 95% CI 0.21-1.29) or surgical site skin infection (RR 1.44, 95% CI 0.43-4.81).
This systematic review and meta-analysis found that extended post-operative antibiotic treatment may not be associated with a reduced risk of intra-abdominal infection; however, meta-analysis was significantly limited by heterogeneity between studies and underpowered trials. Further large randomized controlled trials are needed to confirm these findings.
阑尾炎是最常见的需要手术治疗的急性腹痛病因，估计一生中的发病风险在 7%至 8%之间。抗生素在治疗中起着重要作用，关于抗生素治疗阑尾炎的持续时间存在很大争议。
我们从开始到 2019 年 6 月在多个数据库中搜索了比较成人急性复杂性阑尾炎阑尾切除术后不同抗生素治疗持续时间的同行评审研究。我们将报告数据分为短期和长期抗生素使用，并在荟萃分析中控制不同的定义阈值。我们使用受限最大似然方法和混合效应模型为每个感兴趣的结果生成风险比。
共有 4 项观察性研究纳入了 847 名参与者进行荟萃分析。对于主要结局指标腹腔内感染，我们未发现长期和短期抗生素策略之间存在统计学差异（风险比 0.92，95%置信区间 0.49-1.74）。另外有 3 项随机对照试验纳入了 291 名参与者进行单独的荟萃分析。我们发现，延长抗生素使用与腹腔内感染（RR 0.52，95%置信区间 0.21-1.29）或手术部位皮肤感染（RR 1.44，95%置信区间 0.43-4.81）的风险降低无统计学意义相关。
这项系统评价和荟萃分析发现，术后延长抗生素治疗可能不会降低腹腔内感染的风险；然而，荟萃分析受到研究间异质性和试验效力不足的显著限制。需要进一步开展大型随机对照试验来证实这些发现。
