Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.2.2 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Lang 1988 [13] Australia RCT Appendectomy. 167 mITT Female/male: 59/108. Mean age: 25 years. n=240 Follow-up 4 weeks I: Cefoxitin 1 g x 1 (female/male: 29/53) (n=82) C: Ceftriaxone 1 g x 1 (female/male: 30/55) (n=85) Wound infection I: 6 pts (7.3%) C: 8 pts (9.4%) LRTI (productive cough and/or X-ray evidence) I: 0 pts C: 2 pts UTI (≥10 8 cfu/l or fever >38.5 o C for which antibiotic therapy was given) I: 1 pt C: 0 pts 73 pts Moderate More males. Wound infection was defined as discharge of pus whether a bacteria was cultured or not or serous fluid from which bacteria were isolated Mosimann 1997 [17] Switzerland RCT Colorectal surgery. Female/male: 151/171. Mean age: 65.8 years, range 16–96. n=449 Follow-up daily the first 7 days and at day 42 by telephone I: Amoxicillin/clavulanic acid 1.2 g at 0, 8, 16 h (n=160) C: Gentamicin 80 mg + 600 mg clindamycin at 0, 8 and 16 h (n=162) Wound infection by ASEPSIS system I: 11.1% C: 10.9% Intraabdominal infection I: 1 pt C: 7 pts p=0.0352 97 excluded before and 30 pts after randomisation High Relevant, big study. In metaanalysis [1] Mortality I: 6 pts C: 2 pts, ns 79 pts had symptomatic infectious episodes mostly UTI and RTI. ns between the groups. LOS ns between the groups The table continues on the next page 170 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 171
Table 4.2.2 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Nelson 2009 [1] Systematic review All trials between 1980 to december 2007 concerning the efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery. 182 relevant trials were found through Medline, EmBase and Cochrane I1: Antibiotics prophylaxis (n=461) I2: Single-dose (n=757) I3: Aerobic cover + anaerobic cover (n=648) I4: Aerobic cover + anaerobic cover (n=1 184 included) I5: Combined non-absorbable oral + intravenous prophylaxis (n=1 176) I6: Combined non-absorbable oral + intravenous prophylaxis (n=143) I7: Antibiotic choice 28 trials C1: No antibiotics (n=352) C2: Multiple doses (n=1 784) C3: No aerobic cover (n=621) C4: No anaerobic cover (n=1 210) C5: Intravenous prophylaxis alone (n=1 186) C6: Oral nonabsorbable prophylaxis alone (n=140) C7: Gold standard (cefotetan, cefoxitin, doxycycline, oral neomycin/ erythromycinbase). 28 trials Surgical wound infection 1. Favour antibiotic prophylaxis vs no antibiotics RR=0.30 (95% CI 0.22–0.41). 2. Single dose vs multiple doses RR=1.06 (95% CI 0.88–1.27) 3. Favour additional aerobic cover RR=0.41 (95% CI 0.23–0.71) 4. Favour additional anaerobic cover RR=0.55 (95% CI 0.35–0.85) 5. Favour combined nonabsorbable oral and iv therapy vs iv therapy RR=0.55 (95% CI 0.41–0.74) 6. Favour combined non-absorbable oral and iv therapy vs non-absorbable oral therapy RR=0.34 (95% CI 0.134–0.87) 7. Different antibiotic vs gold standard RR=0 (95% CI 0.0–0.0) High Cochrane analysis with high quality. The quality of studies improved over the years. Studies in all language were considered (161 in english) The table continues on the next page 172 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 173
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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
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Urologi Samtliga 13 kliniker som be
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Tabell 3.1.2 Finns skriftliga anvis
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72 antibiotikaprofylax vid kirurgis
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esistens). STRAMA-gruppen har delat
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Tabell 3.2.2 fortsättning Preparat
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Tabell 3.2.2 fortsättning Preparat
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4. Den systematiska litteraturöver
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4.1 Antibiotikaprofylax vid gastroi
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• Blindtarmsinflammation: Antibio
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Frågeställningar • Vilken typ a
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Weber och medarbetare publicerade 2
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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 114 and 115: Table 4.1.13 Appendectomy. Author Y
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
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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
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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
Page 164 and 165: Vid bakteriell vaginos som kan vara
Page 166 and 167: Beskrivning av studier och resultat
Page 168 and 169: endometrit (1 procent vs 5 procent)
Page 170 and 171: [4]. Inga av de förhållandevis f
Page 172 and 173: frekvens av infektioner efter profy
Page 174 and 175: Det finns inga data som visar att f
Page 176 and 177: Sterilisering I en stor studie frå
Page 178 and 179: Table 4.4.2 Caesarean section, anti
Page 180 and 181: Table 4.4.3 Caesarean section, comp
Page 182 and 183: Table 4.4.5 Caesarean section, mult
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Table 4.4.8 Hysterectomy, antibioti
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Table 4.4.8 continued Author Year R
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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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