Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Syst Rev. 2024 Sep 3;13(1):224. doi: 10.1186/s13643-024-02639-5.
Surgical site infections continue to be a significant challenge following colorectal surgery. These can result in extended hospital stays, hospital readmissions, increased treatment costs, and negative effects on patients' quality of life. Antibiotic prophylaxis plays a crucial role in preventing infection during surgery, specifically in preventing surgical site infections after colorectal surgery in adult patients. However, the optimal antibiotic regimen is still unclear based on current evidence. Considering the limitations of existing reviews, our goal is to conduct a comprehensive systematic review and network meta-analysis of randomized controlled trials to evaluate the comparative benefits and harms of available antibiotic prophylaxis regimens for preventing surgical site infections following colorectal surgery in adult patients.
We will search the Medline, EMBASE, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases to identify relevant randomized controlled trials. We will include trials that (1) enrolled adults who underwent colorectal surgeries and (2) randomized them to any systemic administration of antibiotic (single or combined) prophylaxis before surgery compared to an alternative systemic antibiotic (single or combined antibiotic), placebo, control, or no prophylactic treatment. Pairs of reviewers will independently assess the risk of bias among eligible trials using a modified Cochrane risk of bias instrument for randomized trials. Our outcomes of interest include the rate of surgical site infection within 30 days of surgery, hospital length of stay, 30-day mortality, and treatment-related adverse effects. We will perform a contrast-based network meta-analysis using a frequentist random-effects model assuming a common heterogeneity parameter. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be utilized to assess the certainty of evidence for treatment effects.
By synthesizing evidence from available RCTs, this study will provide valuable insight for clinicians, patients, and health policymakers on the most effective antibiotics for preventing surgical site infection.
PROSPERO CRD42023434544.
结直肠手术后，手术部位感染仍然是一个重大挑战。这可能导致住院时间延长、再次住院、治疗费用增加，并对患者的生活质量产生负面影响。抗生素预防在手术期间发挥着重要作用，特别是在预防成人结直肠手术后手术部位感染方面。然而，基于现有证据，最佳抗生素方案仍不清楚。鉴于现有综述的局限性，我们的目标是对随机对照试验进行全面的系统评价和网络荟萃分析，以评估预防成人结直肠手术后手术部位感染的现有抗生素预防方案的比较效益和危害。
我们将检索 Medline、EMBASE、CINAHL、Scopus 和 Cochrane 中央对照试验注册库，以确定相关的随机对照试验。我们将纳入以下试验：（1）纳入接受结直肠手术的成年人，（2）将其随机分为手术前任何系统给予抗生素（单一或联合）预防与替代系统抗生素（单一或联合抗生素）、安慰剂、对照组或无预防治疗相比。两名审查员将使用改良的 Cochrane 随机试验偏倚工具独立评估合格试验的偏倚风险。我们感兴趣的结局包括手术后 30 天内手术部位感染率、住院时间、30 天死亡率和治疗相关不良反应。我们将使用基于固定效应模型的对比网络荟萃分析，假设共同异质性参数。将使用推荐评估、制定和评价（GRADE）方法评估治疗效果的证据确定性。
通过综合现有 RCT 的证据，本研究将为临床医生、患者和卫生政策制定者提供有价值的见解，了解预防手术部位感染最有效的抗生素。
PROSPERO CRD42023434544。
