Vicentini Costanza, Gianino Maria Michela, Corradi Alessio, Marengo Noemi, Bordino Valerio, Corcione Silvia, De Rosa Francesco Giuseppe, Fattore Giovanni, Zotti Carla Maria
Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy.
Department of Medical Sciences, Infectious Diseases, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.
Antibiotics (Basel). 2021 Mar 4;10(3):259. doi: 10.3390/antibiotics10030259.
Standard surgical antimicrobial prophylaxis (SAP) regimens are less effective in preventing surgical site infections (SSIs) due to rising antimicrobial resistance (AMR) rates, particularly for patients undergoing colorectal surgery. This study aimed to evaluate whether ertapenem should be a preferred strategy for the prevention of SSIs following elective colorectal surgery compared to three standard SAP regimens: amoxicillin-clavulanate, cefoxitin, and cefazolin plus metronidazole. A cost-effectiveness analysis was conducted using decision tree models. Probabilities of SSIs and AMR-SSIs, costs, and effects (in terms of quality-adjusted life-years) were considered in the assessment of the alternative strategies. Input parameters integrated real data from the Italian surveillance system for SSIs with data from the published literature. A sensitivity analysis was conducted to assess the potential impact of the decreasing efficacy of standard SAP regimens in preventing SSIs. According to our models, ertapenem was the most cost-effective strategy only when compared to amoxicillin-clavulanate, but it did not prove to be superior to cefoxitin and cefazolin plus metronidazole. The sensitivity analysis found ertapenem would be the most cost-effective strategy compared to these agents if their failure rate was more than doubled. The findings of this study suggest ertapenem should not be a preferred strategy for SAP in elective colorectal surgery.
由于抗菌药物耐药性（AMR）率不断上升，标准外科抗菌药物预防（SAP）方案在预防手术部位感染（SSIs）方面效果较差，尤其是对于接受结直肠手术的患者。本研究旨在评估与三种标准SAP方案（阿莫西林-克拉维酸、头孢西丁、头孢唑林加甲硝唑）相比，厄他培南是否应作为择期结直肠手术后预防SSIs的首选策略。使用决策树模型进行了成本效益分析。在评估替代策略时，考虑了SSIs和AMR-SSIs的概率、成本和效果（以质量调整生命年计）。输入参数整合了意大利SSIs监测系统的实际数据和已发表文献的数据。进行了敏感性分析，以评估标准SAP方案预防SSIs疗效下降的潜在影响。根据我们的模型，仅与阿莫西林-克拉维酸相比时，厄他培南是最具成本效益的策略，但它并未证明优于头孢西丁和头孢唑林加甲硝唑。敏感性分析发现，如果这些药物的失败率增加一倍以上，与它们相比，厄他培南将是最具成本效益的策略。本研究结果表明，在择期结直肠手术中，厄他培南不应作为SAP的首选策略。
