Bwire George Msema, Magati Renatus B, Ntissi Hafidhi H, Mbilinyi Tusaligwe, Manguzu Martine A, Nyondo Goodluck G, Njiro Belinda J, Nkinda Lilian B, Munishi Castory G, Nyongole Obadia, Ndayishimiye Pacifique, Majigo Mtebe V
Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania.
Department of Clinical Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Syst Rev. 2025 Jan 8;14(1):7. doi: 10.1186/s13643-024-02750-7.
Postoperative antibiotic prophylaxis (PAP) involves using antibiotics after surgery to prevent surgical site infections (SSIs). However, studies have shown that PAP offers no additional benefits compared to discontinuation after surgical incision closure, prompting its de-implementation to prevent unnecessary antibiotic use that may contribute to antibiotic resistance. We conducted this review to synthesize evidence for guiding the design and implementation of effective strategies for discontinuing PAP practice and optimizing antibiotic use in surgical settings.
This umbrella review searched for articles from PubMed/MEDLINE and Scopus, focusing on reviews conducted on human subjects on PAP to prevent SSIs, published in English language from 2019 to 5th July 2024. This review followed guidelines from PRISMA-P and PRIOR. The risk of bias (methodological quality) was assessed using AMSTAR-2. The pooled risk ratio (RR) was estimated using a fixed-effects model (Mantel-Haenszel method), while I was used to assess the heterogeneity between reviews. This review was registered with PROSPERO (CRD42024566124).
In our umbrella review, we screened 1156 articles, with 28 review articles found eligible for final analysis, involving over 457 primary studies. About 80,483 patients were involved in 9 meta-analysis reviews, which were used to estimate the pooled RR. We found no significant benefits to patients from continuing PAP beyond 24-h post-surgery compared to immediate discontinuation, RR: 1.07 (95% CI: 0.97-1.17, I: 25%, p-value: 0.22). Strategies such as regularly assessing and refining guidelines to fit specific surgical settings and patients' characteristics, multidisciplinary collaboration, availability of resources needed for best practices, education and training healthcare workers on SSI prevention and antibiotic stewardship, and patient education in SSI prevention and proper antibiotic use were recommended to improve best practices in surgical settings.
Prolonging antibiotic prophylaxis beyond 24-h post-surgery did not show significant protective benefits against SSIs. Our findings support the 2018 WHO recommendation for the immediate discontinuation of PAP following surgical incision closure in clean and clean-contaminated procedures. Further de-implementation research studies are needed to guide the effective discontinuation of PAP practice.
术后抗生素预防（PAP）是指在手术后使用抗生素以预防手术部位感染（SSI）。然而，研究表明，与手术切口关闭后停用抗生素相比，PAP并无额外益处，这促使其不再实施，以防止可能导致抗生素耐药性的不必要抗生素使用。我们进行了这项综述，以综合证据，指导设计和实施有效的策略，以停止PAP实践并优化手术环境中的抗生素使用。
本系统综述检索了来自PubMed/MEDLINE和Scopus的文章，重点关注2019年至2024年7月5日以英文发表的关于人类受试者预防SSI的PAP的综述。本综述遵循PRISMA-P和PRIOR的指南。使用AMSTAR-2评估偏倚风险（方法学质量）。使用固定效应模型（Mantel-Haenszel法）估计合并风险比（RR），同时使用I统计量评估各综述之间的异质性。本综述已在PROSPERO（CRD42024566124）注册。
在我们的系统综述中，我们筛选了1156篇文章，发现28篇综述文章符合最终分析的条件，涉及457项以上的原始研究。约80483名患者参与了9项荟萃分析综述，这些综述用于估计合并RR。我们发现，与立即停用相比，术后24小时后继续进行PAP对患者没有显著益处，RR：1.07（95%CI：0.97-1.17，I²：25%，p值：0.22）。建议采取定期评估和完善指南以适应特定手术环境和患者特征、多学科协作、提供最佳实践所需资源、对医护人员进行SSI预防和抗生素管理教育和培训以及对患者进行SSI预防和正确使用抗生素教育等策略，以改善手术环境中的最佳实践。
术后24小时后延长抗生素预防对SSI没有显著的保护益处。我们的研究结果支持世界卫生组织2018年的建议，即在清洁和清洁-污染手术中，手术切口关闭后立即停止PAP。需要进一步开展去实施研究，以指导有效停止PAP实践。
