Department of Surgery, Amsterdam UMC (location AMC), Amsterdam Gastroenterology Endocrinology & Metabolism (AGEM), University of Amsterdam, The Netherlands.
Ann Surg. 2022 Jun 1;275(6):1050-1057. doi: 10.1097/SLA.0000000000005436. Epub 2022 Mar 11.
The aim of this study was to determine the effect of preoperative surgical antibiotic prophylaxis (SAP) with additional intraoperative redosing compared to single-dose preoperative surgical antibiotic prophylaxis on the incidence of surgical site infections (SSI).
Preoperative SAP is standard care for the prevention of SSI. During long surgical procedures, additional intraoperative redosing of SAP is advised, but there is great variability in redosing strategies and compliance rates.
We performed a systematic search of MEDLINE (PubMed), Embase, CINAHL and CENTRAL on June 25th, 2021 according to PROSPERO registration CRD42021229035. We included studies that compared the effect of preoperative SAP with additional intraoperative redosing to single dose preoperative SAP (no redosing) on SSI incidence in patients undergoing any type of surgery. Two researchers performed data appraisal and extraction of summary data independently. Meta-analyses were stratified per study type. We used a generic inverse variance random-effects model to estimate a pooled odds ratio with corresponding 95% confidence intervals (CIs).
We included 2 randomized controlled trials (RCT) and 8 cohort studies comprising of 9470 patients. Pooled odds ratios for SSI in patients receiving intraoperative redosing compared to those without redosing were 0.47 (95% CI: 0.19-1.16. I2 = 36%) for RCTs and 0.55 (95% CI: 0.38-0.79, I2 = 56%) for observational cohorts. There was considerable clinical heterogeneity among antibiotics used and redosing protocols. GRADE-assessment showed overall low certainty of evidence.
Intraoperative redosing of SAP may reduce incidence of SSI compared to a single dose preoperative SAP in any type of surgery, based on studies with considerable heterogeneity of antibiotic regimens and redosing protocols.
本研究旨在确定与单次术前预防性使用抗生素（SAP）相比，术中追加剂量的 SAP 对手术部位感染（SSI）发生率的影响。
术前 SAP 是预防 SSI 的标准护理。在手术时间较长的情况下，建议术中追加 SAP，但 SAP 的追加策略和依从率存在很大差异。
我们根据 PROSPERO 注册 CRD42021229035，于 2021 年 6 月 25 日在 MEDLINE（PubMed）、Embase、CINAHL 和 CENTRAL 进行了系统检索。我们纳入了比较任何类型手术中 SAP 术中追加剂量与单次术前 SAP（不追加剂量）对 SSI 发生率影响的研究。两名研究人员独立进行数据评估和汇总数据提取。根据研究类型对 Meta 分析进行分层。我们使用通用倒数方差随机效应模型估计汇总比值比及其对应的 95%置信区间（CI）。
我们纳入了 2 项随机对照试验（RCT）和 8 项队列研究，共包含 9470 名患者。接受术中追加剂量的患者与未接受追加剂量的患者相比，SSI 的汇总比值比为 0.47（95%CI：0.19-1.16，I²=36%），对于 RCT 为 0.55（95%CI：0.38-0.79，I²=56%），对于观察性队列。抗生素的使用和追加方案存在相当大的临床异质性。GRADE 评估表明证据总体质量较低。
基于抗生素方案和追加方案存在较大异质性的研究，与单次术前 SAP 相比，SAP 术中追加剂量可能会降低任何类型手术的 SSI 发生率。
