Grewal Simran, Reuvers J Reinder D, Abis Gabor S A, Otten René H J, Kazemier Geert, Stockmann Hein B A C, van Egmond Marjolein, Oosterling Steven J
Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, De Boelelaan 1108, 1081 HZ Amsterdam, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Biomedicines. 2021 Sep 9;9(9):1184. doi: 10.3390/biomedicines9091184.
Surgical-site infection (SSI) and anastomotic leakage (AL) are major complications following surgical resection of colorectal carcinoma (CRC). The beneficial effect of prophylactic oral antibiotics (OABs) on AL in particular is inconsistent. We investigated the impact of OABs on AL rates and on SSI.
A systematic review and meta-analysis of recent RCTs and cohort studies was performed including patients undergoing elective CRC surgery, receiving OABs with or without mechanical bowel preparation (MBP). Primary outcomes were rates of SSI and AL. Secondarily, rates of SSI and AL were compared in broad-spectrum OABs and selective OABs (selective decontamination of the digestive tract (SDD)) subgroups.
Eight studies (seven RCTs and one cohort study) with a total of 2497 patients were included. Oral antibiotics combined with MBP was associated with a significant reduction in SSI (RR = 0.46, 95% confidence interval (CI) 0.31-0.69), I = 1.03%) and AL rates (RR = 0.58, 95% CI 0.37-0.91, I = 0.00%), compared to MBP alone. A subgroup analysis demonstrated that SDD resulted in a significant reduction in AL rates compared to broad-spectrum OABs (RR = 0.52, 95% CI 0.30 to 0.91), I = 0.00%).
OABs in addition to MBP reduces SSI and AL rates in patients undergoing elective CRC surgery and, more specifically, SDD appears to be more effective compared to broad-spectrum OABs in reducing AL.
手术部位感染（SSI）和吻合口漏（AL）是结直肠癌（CRC）手术切除后的主要并发症。预防性口服抗生素（OABs）对AL的有益作用尤其不一致。我们研究了OABs对AL发生率和SSI的影响。
对近期的随机对照试验（RCTs）和队列研究进行系统评价和荟萃分析，纳入接受择期CRC手术、接受或未接受机械肠道准备（MBP）的OABs患者。主要结局是SSI和AL的发生率。其次，在广谱OABs和选择性OABs（消化道选择性去污（SDD））亚组中比较SSI和AL的发生率。
纳入八项研究（七项RCTs和一项队列研究），共2497例患者。与单独使用MBP相比，口服抗生素联合MBP可显著降低SSI（相对风险（RR）=0.46，95%置信区间（CI）0.31-0.69，I²=1.03%）和AL发生率（RR=0.58，95%CI 0.37-0.91，I²=0.00%）。亚组分析表明，与广谱OABs相比，SDD可显著降低AL发生率（RR=0.52，95%CI 0.30至0.91），I²=0.00%）。
在接受择期CRC手术的患者中，OABs联合MBP可降低SSI和AL发生率，更具体地说，与广谱OABs相比，SDD在降低AL方面似乎更有效。
