Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.8.5 Alternatives to intravenous antibiotics. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Desmond 2003 [37] United Kingdom Cohort study 14 pts with elective arterial surgery were prospectively studied. One surgeon. Study absorption and systemic levels of vancomycin. Serum samples at 30, 60 120, 180 and 730 min in 7 pts and at 60 and 180 min, 7 pts. In 4 pts samples from chest drains. 10 pts urinary samples Iv prophylaxis according to routine (type not stated). At closure of sternotomy pts were randomised to I1: 500 mg vancomycin powder I2: 500 mg vancomycin powder dissolved in 10 mL saline Serum samples No difference between groups in serum or urinary levels. Peak serum levels at 30 min (mean 2.96 mg/l; 0.99–5.00). At 6 h 1.32 mg/l (0.56–2.17) T1/2 5 h. Chest drain levels: 11.3 mg/l (0.52–29.4) Moderate Significant systemic levels of vancomycin and in urine for 5 days. Recommended systemic concentration: 5–10 mg/l. Small patient study. Local therapy exposes patients to systemic and urinary vancomycin in significant doses, but the exposure below dose required to inhibit Staphylococcus aureus Eklund 2005 [38] Finland RCT 557 pts undergoing elective CABG during 1 year. Sealed envelopes. SSI defined. Follow-up 3 months I: 10 cm x 10 cm gentamicin – collagen implant (130 mg gentamicin and 280 mg collagen) before wound closure. 2 doses iv cefuroxime 1.5 g 0 and 6 h. In addition iv vancomycin 500 mg on two occasions if hospital stay >72 h C: No implant 2 doses iv cefuroxime 1.5 g and 0 and 6 h in addition iv vancomycin 500 mg on two occations if hospital stay >72 h Sternal wound infection I: 11/272 (4.0%) C: 16/270 (5.9%) p=0.201 Mediastinitis I: 3/272 (1.1%) C: 5/270 (1.9%) p=0.470 20 pts did not meet inclusion criteria 5 refused to participate 4 deceased Moderate No difference. Slightly better results in intervention group. No side effects. Safe therapy Gram positive organisms accounted for most infections The table continues on the next page 388 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 389
Table 4.8.5 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 Friberg 2005 [39] Sweden RCT All pts undergoing cardiac surgery (including surgery on ascending aorta) through median sternotomy. Two centres. Elective and emergency. Follow-up 2 months I: Two sponges in the wound before closure gentamicin sulphate 200 mg and 280 mg collagen + iv antibiotic prophylaxis a) Cloxacillin 2 g every 8 h for 24–48 h (1 center) b) Dicloxacillin 1 g every 8 h for 24–48 h (1 centre) Pre-op oral mouthwash the night and morning with chlorhexidine at one centre 1 000 pts randomised, 983 analyzed C: No sponge. Iv prophylaxis as intervention group. 1 000 pts randomised, 967 analyzed Sternal wound infection, total I: 4.3% C: 9.0% OR 0.47 (95% CI 0.33–0.68) Sternal wound infection, superficial I: 1.8% C: 5.7% OR 0.34 (95% CI 0.20–0.57) Sternal wound infection, deep I: 2.3% C: 3.3% OR 0.71 (95% CI 0.42–1.20) 17 interventions (differential operations, lost to follow-up) 33 controls (differential operations, lost to follow-up) High 53% relative reduction. No placebo control. Difference in deep infections not statistically significant Perl 2002 [42] USA RCT Adults who underwent general, oncologic, gynaecologic, elective non-emergency cardiothoracic and neurologic surgical procedures. Screened 4 030, in analyses 3 864 I: Swabs applied mupirocin intranasal for up to 5 days C: Swabs applied placebo intranasal for up to 5 days SSI with Staphylococcus aureus I: 2.3% C: 2.4% SSI with Staphylococcus aureus in pts with nasal carriage of Staphylococcus aureus preoperatively: n=891/3 864 (23.1%) I: 444 pts (4.0%) C: 447 pts (7.7%) OR for infection with treatment 0.49 (95% CI 0.25–0.92) p=0.02 79 of randomised, 249 in I and 209 in C, 21 did nor receive any drug. No reasons given Moderate The table continues on the next page 390 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 391
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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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Accidentell perforation under opera
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Ventrikelkirurgi (Tabell 4.1.10) Ba
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Det finns idag inga RCT av antibiot
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Table 4.1.3 Timing. Author Year Ref
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Table 4.1.4 continued Author Year R
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Table 4.1.6 ERCP. Author Year Refer
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Table 4.1.9 Oesophagus. Author Year
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Table 4.1.10 continued Author Year
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Table 4.1.12 Hernia repair. Author
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Table 4.1.13 Appendectomy. Author Y
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Referenser 1. Bai Y, Gao F, Gao J,
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laxis during elective upper gastroi
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57. Sanchez-Manuel FJ, Lozano Garci
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152 antibiotikaprofylax vid kirurgi
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• De flesta studier har jämfört
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Frågeställningar • Vilken antib
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(RR = 0,41; 95 procent KI = 0,23-0,
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Diskussion Idag använder 67 procen
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Table 4.2.2 Elective colorectal sur
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Table 4.2.3 Elective colorectal sur
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mycin as antibiotic prophylaxis in
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Bakgrund Infektioner hos patienter
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Beskrivning av studier och resultat
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Table 4.3.2 Vascular surgery. Autho
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Table 4.3.3 Low study quality and r
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Referenser 1. Christenson JT, Eklof
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a randomized, prospective trial. So
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Elektivt sectio (generellt) • Ant
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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 4.4.8 Hysterectomy, antibioti
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Table 4.4.10 Hysterectomy, duration
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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
Page 244 and 245: 45. Nungu KS, Olerud C, Rehnberg L,
Page 246 and 247: 324 antibiotikaprofylax vid kirurgi
Page 248 and 249: Det är oklart om antibiotikaprofyl
Page 250 and 251: Resultat av litteratursökningen oc
Page 252 and 253: Två artiklar med medelhög kvalite
Page 254 and 255: Övrig plastikkirurgi Två artiklar
Page 256 and 257: Table 4.6.2 Skin surgery. Author Ye
Page 258 and 259: Table 4.6.3 Breast surgery. Author
Page 260 and 261: Table 4.6.4 Abdominoplasty. Author
Page 262 and 263: Referenser 1. Amland PF, Andenaes K
Page 264 and 265: 348 antibiotikaprofylax vid kirurgi
Page 266 and 267: I en del situationer görs en omede
Page 268 and 269: Bröstcancerbehandling har genomgå
Page 270 and 271: Table 4.7.2 Breast cancer operation
Page 272 and 273: 4.8 Antibiotikaprofylax vid hjärtk
Page 274 and 275: Det finns flera för hjärtkirurgi
Page 276 and 277: Bakteriologi/bakteriologisk miljö
Page 278 and 279: Alternativ till antibiotikaprofylax
Page 280 and 281: Preparatval (Tabell 4.8.3) Det stor
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Page 284 and 285: studier av effektivitet och resiste
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Page 288 and 289: Table 4.8.3 Choice of antibiotics.
Page 298 and 299: 14. Kadurugamuwa JL, Beveridge TJ.
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Page 302 and 303: 4.9 Antibiotikaprofylax vid implant
Page 304 and 305: Resultat av litteratursökningen oc
Page 306 and 307: KAPITEL 4 • den systematiska litt
Page 310 and 311: 4.10 Antibiotikaprofylax vid allmä
Page 312 and 313: tionstekniken har även ändrats se
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Page 316 and 317: etiologi som uppkomstmekanism. Dett
Page 318 and 319: Table 4.10.2 continued Author Year
Page 320 and 321: Referenser 1. Aznar R, Mateu M, Mir
Page 322 and 323: Tabell 4.11.1 Antibiotikaprofylax j
Page 324 and 325: medelhög kvalitet. Fyra av de ing
Page 326 and 327: av hemothorax har vidare angivits s
Page 328 and 329: Table 4.11.1 Penetrating injuries o
Page 330 and 331: Referenser 1. Fallon WF, Jr, Wears
Page 332 and 333: • Stötvågsbehandling av njurste
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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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