From the Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Man. (Johnson, Helewa); the Clinician Investigator Program, University of Manitoba, Winnipeg, Man. (Johnson); the Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Ziegler); the University of Manitoba, Winnipeg, Man. (Askin); the George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Man. (Rabbani, Abou-Setta); and the Department of Community Health Sciences, University of Manitoba, Winnipeg, Man. (Rabbani, Abou-Setta)
From the Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Man. (Johnson, Helewa); the Clinician Investigator Program, University of Manitoba, Winnipeg, Man. (Johnson); the Department of Internal Medicine, University of Manitoba, Winnipeg, Man. (Ziegler); the University of Manitoba, Winnipeg, Man. (Askin); the George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Man. (Rabbani, Abou-Setta); and the Department of Community Health Sciences, University of Manitoba, Winnipeg, Man. (Rabbani, Abou-Setta).
Can J Surg. 2023 Jan 18;66(1):E21-E31. doi: 10.1503/cjs.019721. Print 2023 Jan-Feb.
Preoperative treatment with oral neomycin combined with erythromycin or metronidazole is recommended to decrease the risk of surgical site infections (SSIs) in elective colorectal surgery. However, oral neomycin is not commercially available in Canada, and therefore it is not routinely used. Fluoroquinolones are widely available and have excellent activity against aerobic Gram-negative bacteria. The aim of this systematic review was to identify, critically appraise and summarize the evidence on the efficacy and safety of preoperative use of oral fluoroquinolone antibiotics for the prevention of SSIs in adult patients undergoing elective colorectal resection.
Following Cochrane guidelines, we included English-language randomized controlled trials (RCTs) comparing oral fluoroquinolones plus routine preoperative intravenous antibiotics against intravenous antibiotics alone from MEDLINE (Ovid), Embase (Ovid), the Cochrane Central Register of Controlled Trials( Ovid) and ClinicalTrials.gov.
We included 3 RCTs (1136 patients). Risk of bias was uncertain in 2 trials and high in 1 trial. Preoperative oral fluoroquinolones led to significantly decreased total SSIs (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.32-0.57, = 0%), superficial incisional (RR 0.38, 95% CI 0.22-0.68, = 32%), deep incisional (RR 0.19, 95% CI 0.06-0.65, = 0%) and organ/space SSIs (RR 0.34, 95% CI 0.12-0.90, = 33%). There was also a significant reduction in anastomotic leaks (RR 0.22, 95% CI 0.06-0.87, = 0%). No antibiotic-related adverse events were reported.
This review suggests that preoperative oral fluoroquinolones with intravenous antibiotics are superior to intravenous antibiotics alone for preventing SSIs after colorectal surgery. If neomycin is unavailable, oral fluoroquinolones should be considered as a reasonable alternative. Future trials are required to further compare the relative efficacy of oral antibiotic regimens.
术前口服新霉素联合红霉素或甲硝唑治疗可降低择期结直肠手术部位感染（SSI）的风险。然而，加拿大市售药物中并不包含新霉素，因此也无法常规使用。氟喹诺酮类药物应用广泛，对需氧革兰氏阴性菌具有良好的活性。本系统评价旨在确定、评价并总结术前口服氟喹诺酮类抗生素预防择期结直肠切除术后成人 SSI 的疗效和安全性的证据。
根据 Cochrane 指南，我们检索了 MEDLINE（Ovid）、Embase（Ovid）、Cochrane 中央对照试验注册库（Ovid）和 ClinicalTrials.gov 中以英文发表的比较口服氟喹诺酮类药物联合常规术前静脉用抗生素与单独静脉用抗生素的随机对照试验（RCT）。
共纳入 3 项 RCT（1136 例患者）。其中 2 项研究的偏倚风险不确定，1 项研究的偏倚风险较高。术前口服氟喹诺酮类药物可显著降低总 SSI 发生率（风险比 [RR] 0.43，95%置信区间 [CI] 0.32-0.57， = 0%）、浅部切口 SSI（RR 0.38，95% CI 0.22-0.68， = 32%）、深部切口 SSI（RR 0.19，95% CI 0.06-0.65， = 0%）和器官/腔隙 SSI（RR 0.34，95% CI 0.12-0.90， = 33%），吻合口漏的发生率也显著降低（RR 0.22，95% CI 0.06-0.87， = 0%）。未见与抗生素相关的不良事件。
本评价提示，与单独静脉用抗生素相比，术前口服氟喹诺酮类药物联合静脉用抗生素可更有效地预防结直肠手术后的 SSI。如果无法使用新霉素，可考虑将口服氟喹诺酮类药物作为合理的替代药物。需要进一步开展研究比较不同口服抗生素方案的相对疗效。
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