Antibiotikaprofylax vid kirurgiska ingrepp - SBU
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Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.1.3 Timing.<br />

Author<br />

Year<br />

Reference<br />

Country<br />

Study<br />

design<br />

Population<br />

characteristics<br />

Intervention<br />

Method<br />

Number indi<strong>vid</strong>uals<br />

Control<br />

Number<br />

indiviuduals<br />

Results<br />

Withdrawal<br />

Drop outs<br />

Study quality<br />

and relevance<br />

Comments<br />

Classen<br />

1992<br />

[5]<br />

USA<br />

Prospective<br />

cohort<br />

Timing of antibiotic prophylaxis.<br />

Follow-up 12 months<br />

(6 month 1985 and 6 month<br />

1986).<br />

2 847 pts undergoing clean or<br />

clean-contaminated operations.<br />

Abdominal hysterectomy the<br />

most common (10%).<br />

Female/male: 1 758/1 089.<br />

Age: 11–97 years.<br />

All pat received prophylaxis<br />

at least 24 h post-op and<br />

>80% received prophylaxis at<br />

least for 48 h. 4 antibiotics<br />

(all intravenous cephalosporins<br />

with short half-life) accounted<br />

for 84% of all antibiotic used<br />

I1: Antibiotic 2 h<br />

before incision<br />

(n=1 708)<br />

I2: Antibiotic during<br />

3 h after incision<br />

(n=282)<br />

I3: Antibiotic between<br />

3 and 24 h after the<br />

incision (n=488)<br />

SSI<br />

I1: 10 pts (0.6%)<br />

I2: 4 pts (1.4%)<br />

RR 2.4 (95% CI 0.9–7.9)<br />

p=0.12<br />

I3: 16 pts (3.3%)<br />

Moderate<br />

The time of<br />

follow-up for SSI<br />

is not mentioned.<br />

Lots of different<br />

operations<br />

Cosimelli<br />

1993<br />

[6]<br />

Italy<br />

Systematic<br />

review<br />

36 RCT, 6 069 pts colorectal<br />

cancer surgery<br />

I: Perioperative<br />

administration<br />

of antibiotics<br />

C: Postoperative<br />

administration<br />

of antibiotics<br />

Perioperative administration<br />

of antibiotics pro<strong>vid</strong>ed fewer<br />

infections than other regimes<br />

p>0.0001<br />

Moderate<br />

Raab<br />

2001<br />

[9]<br />

Sweden<br />

Prospective<br />

study<br />

Elective colorectal surgery<br />

24 pts.<br />

Female/male: 13/11.<br />

Mean age: 57 years (27–81)<br />

Trimethoprimsulphamethoxazole<br />

(160 mg resp 800 mg)<br />

and metronidazole<br />

(2 g) at 06.30 on the<br />

day of the operation<br />

Oral antibiotic prophylaxis<br />

in the morning gives satisfactory<br />

serum concentrations<br />

independently of when the<br />

operation is done during<br />

the day<br />

0 Moderate<br />

Steinberg<br />

2009<br />

[8]<br />

USA<br />

Prospective<br />

study, Multicenter<br />

Cardiac, hip/knee arthroplasty,<br />

hysterectomy<br />

4 472 pts from 29 hospitals<br />

I: Antibiotic prophylaxis<br />

within 30 min<br />

prior to incision<br />

C: Antibiotic<br />

prophylaxis<br />

31–60 min prior<br />

to incision<br />

SSI<br />

I: 1.6%<br />

C: 2.4%<br />

OR 1.74 (95% CI 0.98–3.04)<br />

Moderate<br />

Weber<br />

2008<br />

[7]<br />

USA<br />

Prospective<br />

study<br />

3 836 surgical procedures I: Antibiotics<br />

59–30 min<br />

before incision<br />

C: Antibiotics<br />

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