Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.14.3 Orthognatic surgery. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawals Drop outs Study quality and relevance Comments Baqain 2004 [17] Jordan RCT Pts undergoing orthognathic surgey. Randomised to receive short or long term prophylactic antibiotic. n=34 I: Iv 1 g amoxicillin + 0.5 g 3 h postoperatively + placebo per os x 3 x 5 days Allergic pts: Clindamycin 300 mg iv + 150 mg clindamycin 3 h postoperatively + placebo x 4 x 5 days, per os (n=17) C: Amoxicillin 1 g iv + 0.5 g 3 h postoperatively + amoxicillin 0.5 g per os x 3 x 5 days Allergic pts: Clindamycin 300 mg iv + 150 mg clindamycin 3 h postoperatively + 150 mg placebo x 4 x 5 days, per os (n=17) Score for SSI I: 406 C: 206 p=0.04 Need of additional antibiotics I: 4/17 C: 2/17 None Moderate Power not estimated. Most findings not statistically significant. Difference in infection score Jansisyanont 2008 [21] Thailand RCT Open study Pts treated with orthognathic surgery were enrolled and 122 pts participated in the study and were randomised to receive one of 4 antibiotic prophylaxis regimens. n=137 I1: 1.2 g amoxicillin/clavulanic acid 30 min. Preoperatively and every 8 h during operation and 8 h postoperatively (n=33) I2: 2 million units penicillin G 30 min pre-operatively and every 4 h during operation and 4 h postoperatively (n=29) SSI according to CDC I1: 1/33 pts I2: 0/29 pts I3: 0/28 pts I4: 1/32 pts No sign difference between groups Moderate I3: 1.2 g amoxicillin/clavulanic acid 30 min pre-operatively and every 8 h during operation and 8 h postoperatively + 625 mg tablets amoxicillin/ clavulanic acid every 8 h for 5 days (n=28) I4: 2 million units penicillin G 30 min pre-operatively and every 4h during operation and 4 h postoperatively + 500 mg tablets amoxicillin/ 8 h for 5 days (n=32) The table continues on the next page 540 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 541
Table 4.14.3 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawals Drop outs Study quality and relevance Comments Kang 2009 [5] Korea RCT Open study Pts treated with orthognathic surgery were randomized to receive short or longtime prophylaxis. n=56 I: Cefpiramid 1 g (3rd generation) pre-operatively (n=28) C: Cefpiramid 1 g (3rd generation) pre-operatively + 1 g x 2 for 3 days (n=28) SSI I: 3/28 pts C: 2/28 pts ns Moderate Lindeboom 2003 [6] The Netherlands RCT Consecutive pts. undergoing bilateral sagittal split operation. Randomised to short or long clindamycin prophylaxis. Placebo controlled. Single blinded. n=70 I: Clindamycin single dose 600 mg + 4 x placebo for 24 h (n=35) C: Clindamycin single dose 600 mg + 4 x 600 mg clindamycin for 24 h (n=35) SSI I: 2/35 C: 1/35 ns No drop outs Moderate Power not estimated. Study could be underpowered Zijderveld 1999 [19] The Netherlands RCT Blinded Pts that underwent orthognathic surgery. n=54 I1: Amoxicillin-clavulanic acid 2.2 g for prophylaxis (n=18) I2: Cefuroxime 1.5 g for prophylaxis (n=17) C: Placebo (n=19) SSI I1: 2/18 I2: 3/17 ns C: 10/19 p
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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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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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Page 362 and 363: Table 4.12.12 Low study quality and
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Page 384 and 385: Table 4.13.3 Tonsillectomy. Author
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Page 390 and 391: Table 4.13.6 Rhinosurgery. Author Y
Page 392 and 393: Table 4.13.9 Low study quality and
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Page 416 and 417: Table 4.14.8 Low quality and releva
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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
Page 434 and 435: 5. Infektionsprofylax utan antibiot
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Page 438 and 439: 6. Etiska aspekter Infektioner rela
Page 440 and 441: komplikation roll. Vissa komplikati
Page 442 and 443: • Hur garanterades bästa möjlig
Page 444 and 445: Etisk analys med hjälp av aktörsm
Page 446: Referens 1. Hermerén G. Kunskapens
Page 449 and 450: Granskningen av hälsoekonomisk lit
Page 451 and 452: Distala Duodenum E Coli ”Efficien
Page 453 and 454: KNS Kolecystektomi Kolecystit Koled
Page 455 and 456: Preoperativa Protesendokoardit Pseu
Page 458 and 459: 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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