Sørensen T M, Scahill K, Ruperez J Espinel, Olejnik M, Swinbourne F, Verwilghen D R, Nolff M C, Baines S, Marques C, Vilen A, Duarte E L, Dias M, Dewulf S, Wichtowska A, Valencia A Carranza, Pelligand L, Broens E M, Toutain P L, Alishani M, Brennan M L, Weese J S, Jessen L R, Allerton F
Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlaegevej 16, Frederiksberg C 1870, Denmark; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland.
College of Medicine and Veterinary Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom; Evidensia Södra Djursjukhuset Kungens Kurva, Månskärarvägen 13, Kungens Kurva 14175, Sweden; ESCMID Study Group for Veterinary Microbiology (ESGVM), Basel, Switzerland.
Vet J. 2024 Apr;304:106101. doi: 10.1016/j.tvjl.2024.106101. Epub 2024 Mar 14.
Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.
外科抗菌预防（SAP）被广泛用于降低手术部位感染（SSI）的风险，但SSI降低的比例尚不确定。因此，外科医生在决定是否使用SAP时，很难恰当地权衡个体患者的成本、风险和益处，这使得在初级医疗环境中促进抗菌药物管理具有挑战性。本研究的目的是梳理专注于评估SAP对SSI发生影响的兽医证据，以便识别有一些研究证据的外科手术以及可能存在的知识空白。2021年10月和2022年12月，对Scopus、CAB文摘、科学引文索引核心合集、Embase和MEDLINE进行了系统检索。对记录进行双盲筛选，以确定关于伴侣动物使用SAP和SSI发生率的研究。在筛选的39123条记录中，有34条可获得比较数据，包括：8项随机对照试验（RCT）、23项队列研究（7项前瞻性和16项回顾性）以及3项回顾性病例系列，总共涉及12476只犬猫。提取的数据分别描述了9项和25项研究中的围手术期或术后SAP。在评估伴侣动物SAP的8项RCT中，手术程序覆盖范围偏向于转诊机构的骨科膝关节手术，并且SAP方案、SSI定义和随访期存在很大差异。需要更标准化的数据收集和SSI定义的一致性，以建立更有力的证据来优化患者护理。
