Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.1.4 continued Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number indiviuduals Results Withdrawal Drop outs Study quality and relevance Comments Tocchi 2000 [36] Italy RCT Elective laparoscopic cholecystectomy. Multivariate analysis of risk factors. Observer blinded. SSI defined. Follow-up 4 weeks I: 30 min before anesthesia and at 24 h 2 g cefotaxime (n=44) C: Isotonic saline at same timepoints (n=40) Post-op infection rate I: 3 wound infections, 1 UTI, 1 subhepatic abscess Overall infection rate 11.3% C: 4 wound infections, 1 bronchopneumonia, 2 UTI Overall 15.5% 6 pts Moderate Risk factors: Biliary colic within 30 days prior to operation or DM. Age no risk factor ab = Antibiotics; ASA = Acetylsalysylic acid; C = Control group; CDC = Centers for disease control; CI = Confidence interval; CT = Controlled trial; DB = Double blind; DM = Diabetes mellitus; I = Intervention group; iv = Intravenous; LC = Laparoscopic cholecystectomy; n = Number of patients; NNT = Number needed to treat; NS = Non significant; OC = Open cholecystectomy; OR = Odds ratio; Pts = Patients; q = Every; RCT = Randomised controlled trial; RTI = Respiratory tract infection; SSI = Surgical site infection; UTI = Urinary tract infection 106 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 107
Table 4.1.5 Open cholecystectomy. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Aloj 1991 [66] United Kingdom and Italy RCT Compare to ab. SSI defined. 103 pts with OC. Risk factors evaluated (>60, jaundice, cholangitis, CBD stones, previous biliary surgery). Bile cultures I1: Piperacillin 2 g im before surgery and 12 h interval for 48 h (n=56). I2: Tobramycin 100 mg im at same intervals (n=47) SSI I1: 7 (12.5%) I2: 11 (23.4%) Not stated Moderate Dervisoglou 2006 [23] Greece RCT Compare ampicillin/subactam with coverage of Enterococcus sp vs cephalosporin 1 center. OC (n=288) or laparoscopic cholecystectomy: (n=190). Computer randomisation. Infection defined. Power calculation. 549 evaluated, 418 pts eligible. Follow-up 4 weeks I1: Ampicillin-sulbactam 3 g iv at induction of anesthesia (n=211) I2: Cefuroxime 1.5 g at same schedule (n=207) Wound infection I1: OC 1/211 Lap group: 0/93 I2: OC 18/207 Lap group: 5/97 44 emergency operations, 37 acute cholecystitis, 26 other simultaneous operations, 19 allergy, other diseases High Enterococcus common in infected pts. Fewer diabetic pts in I1 had infection than I2 (equal number of DM). OC was more commonly performed in high-risk pts Fabian 1988 [25] USA RCT Multicenter (5) 10 per trial of two cephalosporins in elective biliary surgery (mostly OC). Computer randomisation. n=260 I1: Cefotetan 2 g iv 30 min prior to operation + 6 h intervals for 24 h I2: Cefoxitin 2 g at same schedule. In later phase 1 g cefotetan dose was used Wound infection I1: 2/155 I2: 2/68 37 pts (14%) protocol violation Moderate No differences. Authors recommend cefotetan Garcia- Rodriguez 1989 [26] Spain RCT 1 451 pts with biliary surgery and gastric resection among others. Complications not separated. Only gallbladder and bile duct surgery I1: Cefotaxime 1 g before operation (n=512). I2: Cefoxitin 2 g in 4 doses, one before, 6, 12 and 18 h post-op (n=514) Wound infection I1: 3.3% I2: 7.5%. Statistically significant 7 pts in total. No info on post-op Moderate Large material. Groups not separated. Majority OC. Cefotaxime most effective Gazzaniga 1992 [16] Italy RCT Ultra short prophylaxis vs short prophylaxis. 44 centres (each centre at least 10 pts). Power calcuation. Follow-up 1 week. Defined SSI I: Ceftazidine 2 g iv at anesthesia induction (n=386) C: Ceftazidine 1 g iv 30 min before operation + 6 and 12 h after first dose (n=382) Wound infection I1: 2.9% C: 3.7% Sepsis I: 0.3% C: 0.3% 12 pts in I and 3 in C because protocol violation Moderate Large study. Low infection rate. Ultra short regimen preferred. Sponsored by Glaxo The table continues on the next page 108 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 109
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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
Page 46 and 47: Till allmänna faktorer räknas ock
Page 49 and 50: 2. Metodik för systematisk littera
Page 51 and 52: Figur 2.1 Granskningsprocessen. Fas
Page 53 and 54: Evidensstyrkan graderades i fyra ni
Page 55 and 56: 3. Antibiotikaprofylax - praxis KAP
Page 57 and 58: 3.1 Praxisundersökning om användn
Page 59 and 60: 100 90 80 70 Procent Ja-svar 60 50
Page 61 and 62: De 37 kliniker som uppgav att de re
Page 63 and 64: Urologi Samtliga 13 kliniker som be
Page 65 and 66: Tabell 3.1.2 Finns skriftliga anvis
Page 67 and 68: 72 antibiotikaprofylax vid kirurgis
Page 69 and 70: esistens). STRAMA-gruppen har delat
Page 71 and 72: Tabell 3.2.2 fortsättning Preparat
Page 73 and 74: Tabell 3.2.2 fortsättning Preparat
Page 76 and 77: 4. Den systematiska litteraturöver
Page 78 and 79: 4.1 Antibiotikaprofylax vid gastroi
Page 80 and 81: • Blindtarmsinflammation: Antibio
Page 82 and 83: Frågeställningar • Vilken typ a
Page 84 and 85: Weber och medarbetare publicerade 2
Page 86 and 87: Accidentell perforation under opera
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
Page 122 and 123: 152 antibiotikaprofylax vid kirurgi
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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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 4.3.2 continued Author Year R
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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 4.4.12 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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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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