Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.13.6 Rhinosurgery. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Andrews 2006 [23] United Kingdom RCT Complex septorhinoplasty surgery, recruited sequentially. n=164 Follow-up at day 10 I: Amoxicillin-clavunalate 1 200 mg x 3 iv initiated at induction of anesthesia. Allergic pts were given erythromycin (n=82) C: 7 day course post-op amoxicillin-clavulanate 375 mg x 3. Allergic pts given erythromycin (n=82) Wound infections I: 7% C: 11% p=0.42 RR 0.67 (95% CI 0.25–1.79) 0 Moderate Single-blinded. Power. Medium Rajan 2005 [24] Australia RCT Single blind Pts undergoing septorhinoplasty. n=200 I: Amoxicillin-clavunalate 2.2 g x 1, 30 min before incision C: Amoxicillin-clavunalate 2.2 g x 1, 30 min before incision followed by po 1 g x 2 for 7 days Wound infections I: 0% C: 3% ns Not reported Moderate Side effects I: 2% C: 29% p=0.03 Weimert 1980 [22] USA RCT Nasal surgery (septal surgery (n=106), rhinoplasty (n=68)). Previous nasal surgery or nasal polyps excluded. Mean age: 34 (18–72) years. n=174 Ampicillin 500 mg po beginning 12 h prior to surgery and continued for 5 post-op days. Allergic pts were given erythromycin 500 mg (n=75) C: No antibiotics (n=99) Local infection and sinusitis I: 2 (2.75%) C: 2 (2%) Not reported Moderate Bacitracin-impregnated gauze as nasal packing. Single-blinded C = Control group; CI = Confidence interval; h = Hours; I = Intervention group; iv = Intravenous; n = Number of patients; pts = Patients; RCT = Randomised controlled trial; RR = Relative risk 516 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 517
Table 4.13.7 Basilar skull fractures. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Study quality and relevance Comments Ratilal 2006 [25] Systematic review Meta-analysis Cochrane collaboration 5 RCT and 17 non-RCT of pts with basilar skull fractures I: Any regimen of antibiotic prophylaxis C: Placebo or no intervention Meningitis I: 10 C: 14 RR 0.69 (95% CI: 0.29–1.61) Moderate No clearly described randomisation. The RCTs included a total of 208 pts C = Control group; CI = Confidence interval; h = Hours; I = Intervention group; iv = Intravenous; n = Number of patients; pts = Patients; RCT = Randomised controlled trial; RR = Relative risk Table 4.13.8 Sinus surgery. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Annys 2000 [27] Belgium RCT Double blind Pts undergoing endoscopic sinus surgery alone, or with endoscopic resection of a septal spine. n=202 I: Cefuroxime axetil 2 x 250 mg (n=101). All received betamethasone for 5 days C: Placebo (n=101). All received betamethasone for 5 days Postoperative infections I: 12 pts C: 18 pts 0 Moderate Jiang 2008 [26] Taiwan RCT Chronic rhinositis (>12 weeks) patients that underwent FESS. n=71 Follow-up after 3 weeks I: 3 week course of amoxicillin + clavulante potassium 375 mg every 8 h after FESS (n=31) C: No antibiotics (n=40) Rhinosinusitis symptom scores I: 14 (8–18) C: 16.5 (11–25.75) n=13 drop outs Moderate Excluded antibiotics within a week before FESS, history of immunodeficiency or previous sinus surgery C = Control group; FESS = Functional endoscopic sinus surgery; I = Intervention group; n= Number of patients; pts = Patients; RCT = Randomised controlled trial 518 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 519
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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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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
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45. Nungu KS, Olerud C, Rehnberg L,
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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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är fastställd. I en undersökning
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Page 348 and 349: Table 4.12.4 Transrectal prostatic
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Page 354 and 355: Table 4.12.6 Transurethral resectio
Page 356 and 357: Table 4.12.8 Extracorporeal Shockwa
Page 360 and 361: Table 4.12.10 Percutaneous nephroli
Page 362 and 363: Table 4.12.12 Low study quality and
Page 364 and 365: Referenser 1. Berry A, Barratt A. P
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Page 384 and 385: Table 4.13.3 Tonsillectomy. Author
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Page 392 and 393: Table 4.13.9 Low study quality and
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Page 408 and 409: Table 4.14.2 Third molar surgery. A
Page 410 and 411: Table 4.14.3 Orthognatic surgery. A
Page 412 and 413: Table 4.14.4 Implant surgery. Autho
Page 414 and 415: Table 4.14.6 Other dentoalveolar su
Page 416 and 417: Table 4.14.8 Low quality and releva
Page 420 and 421: Referenser 1. Esposito M, Grusovin
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Page 430 and 431: Table 4.15.1 Antibiotic prophylaxis
Page 432 and 433: Table 4.15.2 Antibiotic prophylaxis
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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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