Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.1.13 Appendectomy. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Andersen 2005 [4] Denmark Cochrane review Metaanalysis 45 studies including 9 576 pts with appendicitis MZ: 500 mg during op or supp 1 g 1 h before op + 1 g q 8 h for 7 days or supp 1 g pre-op + q 8 h for 3 days + cotrimoxazole 2 mL im pre-op and q 12 h for 3 days or 500 mg iv pre-op and q 8 h for 3 days or 1 g supp pre-op or 1 g supp pre-op and q 8 h for 3 days. PCG 400 000 IU/kg + chloramphenicol 50 mg/kg during op and for 24 h Piperacillin 200 mg/kg pre-op. Cefazolin 500 mg iv pre-op and q 8 h x 4. Trimethoprim 240 mg + sulfametazole 1 200 mg + MZ 1.5 g iv pre-op Trobramycin 1.5 mg + lincomycin 600 mg iv pre-op. Gentamicin 4 mg/kg + clindamycin 15 mg/kg during op and q 8 h for 24 or 72 h or 80 mg iv during operation with or without clindamycin 600 mg iv during operation. Clindamycin 600 mg iv pre-op. Ceftizoxime or cefamandole iv pre-op + 6–12 h post-op. Cefamandole 2 g + carbenicillin 3 g iv pre-op q 6 h for 24 h or alone as above. Cotrimaxozole 2 mL iv pre-op and q 12 h for 3 days. Cefazolin 1 g iv pre-op. Cephaloridine 50 mg/kg iv pre-op and q 6 h for 2 days. Providone iodine locally. Tinidazole 400 mg locally Placebo Wound infection Intraabdominal abscess Length of stay Mortality The use of ab is superior to placebo for preventing wound infection and intraabdominal abscess High No difference if given pre-, per- or postoperatively. No difference if single or multiple drugs are used. No difference if simple or complicated appendicitis ab = Antibiotics; h = Hours; im = Intramuscular; iv = Intravenous; MZ = Metronidazole; PCG = Penicillin G; pts = Patients; q = Every; supp = Suppository 142 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 143
Table 4.1.14 Penetrating abdominal injury. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Bozorgzadeh 1999 [64] USA RCT 2 trauma centres Penetrating abdominal injury. Consecutive pts. 175 gunshot, 125 stab wounds. All underwent laparotomy. Defined SSI. n=314 I1: Cefoxitin 24 h iv with first 1 g dose given in the emergency department + q 6 h 4 total doses (n=148) I2: 5 days of iv cefoxitin as above + q 6 h 20 total doses (n=152) Superficial infection I1: 15 pts (10.1%) I2: 17 pts (11.2%) Intraabdominal infection I1: 9 pts (6.1%) I2: 9 pts (5.9%) Urinary tract infection I1: 16 pts (10.8%) I2: 9 pts (5.9%) 14 patients died within 24 h, protocol violation, allergy to penicillin High Demographics similar. Overall incidence of infection 76 pts (25.3%) no difference between groups. Chock and colon injury predicted infection but no difference between groups 24 h administration sufficient Pneumonia I1: 10 pts (6.8%) I2: 14 pts (9.2%) Kirton 2000 [63] USA RCT 4 trauma centres Penetrating abdominal injury. At least one hollow viscus perforation each. 18–65 years. Computergenerated randomisation. Defined SSI. Coverage of enterococcus. 809 pts screened. 317 (39%) met inclusion criteria. Follow-up 28 days Iv ampicillin/sulbactam 3 g (ampicillin 2 g and sulbactam 1 g) as soon as possible, but not more than 2 h before operation. After receiving 24 h of unblinded ampicillin/ sulbactam, pts were then randomised into one of two groups I1: 4 more days of drugs iv 2 g q 6 h (n=159) I2: 4 more days of normal saline q 6 h (n=158). All demographics similar except race Superficial wound I1: 1 pt I2: 0 pts Intraabdominal abscess I1: 11 pt I2: 12 pts Purulent peritonitis I1: 2 pts I2: 0 pts Pneumonic infection I1: 12 pts I2: 11 pts Urinary tract infection I1: 1 pt I2: 8 pts High Number of total transfusions important risk factor as well as numbers of organs injured and presence of hypotension. The severity of colon injury was not a risk factor – skin left open. Low infection rate overall. Enterococci not a problem. One day of ab enough Overall mortality 1.6% C = Control group; h = Hours; I = Intervention group; iv = Intravenous; n = Number of patients; q = Every; RCT = Randomised controlled trial; SSI = Surgical site infection 144 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 145
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Antibiotikaprofylax vid kirurgiska
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Antibiotikaprofylax vid kirurgiska
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3. Antibiotikaprofylax - praxis 57
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Har antibiotikaimpregnerade grafter
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Resultat av litteratursökningen oc
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4.11 Sluten inläggning av thoraxdr
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5. Infektionsprofylax utan antibiot
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SBU:s sammanfattning och slutsatser
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Bakgrund och syfte Antibiotika i pr
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arhet. Kvalitetsgranskningen av de
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Det vetenskapliga underlaget saknas
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tagning av livmoder (måttligt star
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Bröstcancerkirurgi • Vid bröstc
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sårinfektion, empyem (varansamling
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• Antibiotikaprofylax vid öppen
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Infektiös endokardit Infektiös en
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• Endovaskulära ingrepp, speciel
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1.2 Avgränsningar Projektet omfatt
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Tabell 1.1 Effektmått förutom pos
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Tabell 1.2 fortsättning Antal bakt
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Proteinbindning Många antibiotika
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Till allmänna faktorer räknas ock
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2. Metodik för systematisk littera
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Figur 2.1 Granskningsprocessen. Fas
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Evidensstyrkan graderades i fyra ni
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3. Antibiotikaprofylax - praxis KAP
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3.1 Praxisundersökning om användn
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100 90 80 70 Procent Ja-svar 60 50
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De 37 kliniker som uppgav att de re
Page 63 and 64: Urologi Samtliga 13 kliniker som be
Page 65 and 66: Tabell 3.1.2 Finns skriftliga anvis
Page 67 and 68: 72 antibiotikaprofylax vid kirurgis
Page 69 and 70: esistens). STRAMA-gruppen har delat
Page 71 and 72: Tabell 3.2.2 fortsättning Preparat
Page 73 and 74: Tabell 3.2.2 fortsättning Preparat
Page 76 and 77: 4. Den systematiska litteraturöver
Page 78 and 79: 4.1 Antibiotikaprofylax vid gastroi
Page 80 and 81: • Blindtarmsinflammation: Antibio
Page 82 and 83: Frågeställningar • Vilken typ a
Page 84 and 85: Weber och medarbetare publicerade 2
Page 86 and 87: Accidentell perforation under opera
Page 88 and 89: Ventrikelkirurgi (Tabell 4.1.10) Ba
Page 90 and 91: Det finns idag inga RCT av antibiot
Page 92 and 93: Table 4.1.3 Timing. Author Year Ref
Page 94 and 95: Table 4.1.4 continued Author Year R
Page 102 and 103: Table 4.1.6 ERCP. Author Year Refer
Page 104 and 105: Table 4.1.9 Oesophagus. Author Year
Page 106 and 107: Table 4.1.10 continued Author Year
Page 110 and 111: Table 4.1.12 Hernia repair. Author
Page 116 and 117: Referenser 1. Bai Y, Gao F, Gao J,
Page 118 and 119: laxis during elective upper gastroi
Page 120 and 121: 57. Sanchez-Manuel FJ, Lozano Garci
Page 122 and 123: 152 antibiotikaprofylax vid kirurgi
Page 124 and 125: • De flesta studier har jämfört
Page 126 and 127: Frågeställningar • Vilken antib
Page 128 and 129: (RR = 0,41; 95 procent KI = 0,23-0,
Page 130 and 131: Diskussion Idag använder 67 procen
Page 132 and 133: Table 4.2.2 Elective colorectal sur
Page 142 and 143: Table 4.2.3 Elective colorectal sur
Page 144 and 145: mycin as antibiotic prophylaxis in
Page 146 and 147: Bakgrund Infektioner hos patienter
Page 148 and 149: Beskrivning av studier och resultat
Page 150 and 151: Table 4.3.2 Vascular surgery. Autho
Page 154 and 155: Table 4.3.3 Low study quality and r
Page 156 and 157: Referenser 1. Christenson JT, Eklof
Page 158 and 159: a randomized, prospective trial. So
Page 160 and 161: Elektivt sectio (generellt) • Ant
Page 162 and 163: Transcervikala intrauterina ingrepp
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Vid bakteriell vaginos som kan vara
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Beskrivning av studier och resultat
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endometrit (1 procent vs 5 procent)
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[4]. Inga av de förhållandevis f
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frekvens av infektioner efter profy
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Det finns inga data som visar att f
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Sterilisering I en stor studie frå
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Table 4.4.2 Caesarean section, anti
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Table 4.4.3 Caesarean section, comp
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Table 4.4.5 Caesarean section, mult
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Table 4.4.6 continued Author Year R
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Table 4.4.8 Hysterectomy, antibioti
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Table 4.4.10 Hysterectomy, duration
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Table 4.4.12 continued Author Year
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Table 4.4.14 Intrauterine contracep
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15. Sullivan SA, Smith T, Chang E,
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hysterectomy. Clin Infect Dis 1995;
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urethropexy. Journal of Pelvic Medi
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97. Mangioni C, Bianchi L, Bolis PF
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4.5 Antibiotikaprofylax vid ortoped
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inte sällan i kronisk form. Insät
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Inklusionskriterier Enbart prospekt
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och medarbetare från år 1987 [9]
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(från 1998) samtidigt som man helt
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KAPITEL 4 • den systematiska litt
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Thomsen 1990 [44] Denmark RCT, open
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Table 4.5.3 Closed fractures; durat
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Table 4.5.5 Studies comparing diffe
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Table 4.5.7 Prosthesis, different d
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Table 4.5.9 Prosthesis and antibiot
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Table 4.5.11 Low study quality and
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prophylaxis in trochanteric hip fra
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45. Nungu KS, Olerud C, Rehnberg L,
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324 antibiotikaprofylax vid kirurgi
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Det är oklart om antibiotikaprofyl
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Två artiklar med medelhög kvalite
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Övrig plastikkirurgi Två artiklar
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Table 4.6.2 Skin surgery. Author Ye
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Table 4.6.3 Breast surgery. Author
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Table 4.6.4 Abdominoplasty. Author
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Referenser 1. Amland PF, Andenaes K
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I en del situationer görs en omede
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Bröstcancerbehandling har genomgå
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Table 4.7.2 Breast cancer operation
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4.8 Antibiotikaprofylax vid hjärtk
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Det finns flera för hjärtkirurgi
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Bakteriologi/bakteriologisk miljö
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Alternativ till antibiotikaprofylax
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Preparatval (Tabell 4.8.3) Det stor
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av dessa studier för få patienter
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studier av effektivitet och resiste
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Table 4.8.3 Choice of antibiotics.
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Table 4.8.5 Alternatives to intrave
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14. Kadurugamuwa JL, Beveridge TJ.
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infections after cardiac surgery: a
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4.9 Antibiotikaprofylax vid implant
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KAPITEL 4 • den systematiska litt
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4.10 Antibiotikaprofylax vid allmä
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tionstekniken har även ändrats se
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penicillin och ett dygns cefuroxim
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etiologi som uppkomstmekanism. Dett
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Referenser 1. Aznar R, Mateu M, Mir
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Tabell 4.11.1 Antibiotikaprofylax j
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medelhög kvalitet. Fyra av de ing
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av hemothorax har vidare angivits s
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Table 4.11.1 Penetrating injuries o
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Referenser 1. Fallon WF, Jr, Wears
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• Stötvågsbehandling av njurste
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ersatt den öppna kirurgin för van
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Beskrivning av studier och resultat
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är fastställd. I en undersökning
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0 och 5,1 procent hos patienter uta
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Här följer några exempel: Abdomi
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infektion. Det finns i de redovisad
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Table 4.12.3 Cystoscopy. Author Yea
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Table 4.12.4 Transrectal prostatic
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Table 4.12.6 Transurethral resectio
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Table 4.12.8 Extracorporeal Shockwa
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Table 4.12.10 Percutaneous nephroli
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Referenser 1. Berry A, Barratt A. P
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cin and chloramphenicol. Int Braz J
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urine culture and sensitivity are b
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• Det vetenskapliga underlaget f
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Kirurgiska ingrepp inom öron-näsa
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ständiga artiklarna resulterade i
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Cancerkirurgi (Tabell 4.13.5) En RC
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Sinuskirurgi (Tabell 4.13.8) En ran
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Typ av antibiotika och dos varierad
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Table 4.13.3 Tonsillectomy. Author
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Table 4.13.5 Cancer. Author Year Re
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Table 4.13.6 Rhinosurgery. Author Y
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and neck oncologic surgery. Ann Oto
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• Det vetenskapliga underlaget ä
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Frågeställningar • Vid vilka ki
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Anomalikirurgi (Tabell 4.14.3) Anom
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Övriga kirurgiska ingrepp i käkar
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utförde Lockhart och medarbetare (
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Table 4.14.2 Third molar surgery. A
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Table 4.14.3 Orthognatic surgery. A
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Table 4.14.4 Implant surgery. Autho
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Table 4.14.6 Other dentoalveolar su
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Table 4.14.8 Low quality and releva
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Referenser 1. Esposito M, Grusovin
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preoperative single-dose clindamyci
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• Sjukvården får kostnader för
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358 (p
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Table 4.15.1 Antibiotic prophylaxis
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Table 4.15.2 Antibiotic prophylaxis
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5. Infektionsprofylax utan antibiot
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frekvensen postoperativa sårinfekt
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6. Etiska aspekter Infektioner rela
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komplikation roll. Vissa komplikati
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• Hur garanterades bästa möjlig
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Etisk analys med hjälp av aktörsm
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Referens 1. Hermerén G. Kunskapens
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Granskningen av hälsoekonomisk lit
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Distala Duodenum E Coli ”Efficien
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KNS Kolecystektomi Kolecystit Koled
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Preoperativa Protesendokoardit Pseu
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9. Projektgrupp, externa granskare,
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Adjungerade Mats Bergström Läkare
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Principal Investigator för Sepsiss
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Därutöver konsult/rådgivningsarv
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Rapporter publicerade av SBU Gula r
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Självtestning och egenvård vid an
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Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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