Systematic review and evidence- based guidance ... - ECDC - Europa

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TECHNICAL REPORTSystematic review and evidence-based guidance on perioperative antibiotic prophylaxisModality 5Perioperative prophylaxis should be the responsibility of the anaesthesiologist.Table 13. Studies supporting Modality 5 and quality of evidenceAuthor and designof studyKanter et al. 2008;non-CBATrussell et al. 2001,non-CBAWebb et al. 2006,non-CBAZvonar et al. 2008,non-CBAQuality of study in respect to internal and externalvalidity (Ranji et al. [23])Moderate 2Moderate 2Moderate 2Moderate 2Quality of evidence according to theGRADE approach* [24]* Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityModality 6Perioperative antibiotic prophylaxis should be administered 30 to 60 minutes before incision, ideally at the time ofanaesthetic induction (except for vancomycin and fluoroquinolones).Table 14. Studies supporting Modality 6 and quality of evidenceAuthor and design ofstudyWitt et al. 2011, doubleblindedRCTMannien et al. 2006, non-CBAVan Kasteren et al. 2005,non-CBAWeinberg et al.201 l., ITSstudyWeber et al. 2008, cohortstudyLarochelle et al. 2011,non-CBAQuality of study in respect to internal andexternal validity (Ranji et al. [23])N.A. 4Good 3Good 3Good 3Good 3Moderate 2Liau et al. 2010, non-CBA Moderate 2Young et al. 2011, non-CBAModerate 2Quality of evidence according to theGRADE approach* [24]* Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityN.A. = not applicableModality 7Although a single dose of perioperative antibiotic prophylaxis is preferred, subsequent doses should be givendepending on the duration of the procedure and the half-life of the antibiotic, and if significant blood loss occursduring surgery.Table 15. Studies supporting Modality 7 and quality of evidenceAuthor and design of studyZani et al. 2011, , Cochranesystematic review + meta-analysisGillespie et al. 2010, Cochranesystematic review + meta-analysisMcDonald et al. 1998,systematic review + meta-analysisMeijer et al. 1990systematic review + meta-analysisNelson et al. 2009, Cochranesystematic review + meta-analysisSlobogean et al. 2008,systematic review + meta-analysisQuality of study in respect to internal andexternal validity (Ranji et al. [23])N.A. 4N.A. 3N.A. 3N.A. 3N.A. 3N.A. 3Quality of evidence according tothe GRADE approach [24]*25
Systematic review and evidence-based guidance on perioperative antibiotic prophylaxisTECHNICAL REPORTAuthor and design of studySouthwell-Keely et al. 2004systematic review + meta-analysisQuality of study in respect to internal andexternal validity (Ranji et al. [23])N.A. 3Zannetti et al. 2003, RCT N.A. 3Quality of evidence according tothe GRADE approach [24]** Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityN.A. = not applicableModality 8Prolonging prophylaxis after the end of surgery is not recommended.Table 16. Studies supporting Modality 8 and quality of evidenceAuthor and design of studyZani et al. 2011, Cochrane systematicreview + meta-analysisGillespie et al. 2010, Cochranesystematic review + meta-analysisNelson et al. 2009, Cochranesystematic review + meta-analysisSouthwell-Keely 2004,systematic review + meta-analysisStewart 2008,systematic review + meta-analysisHarbarth 2000; prospective cohortstudyQuality of study in respect to internal andexternal validity (Ranji et al. [23])N.A. 4N.A. 3N.A. 3N.A. 3N.A. 3N.A 3Quality of evidence according tothe GRADE approach [24]** Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityN.A. = not applicableModality 9The perioperative antibiotic protocol should take into account individual patient factors like BMI, underlyingdiseases, or colonisation with resistant pathogens.Table 17. Studies supporting Modality 9 and quality of evidenceAuthor and design ofstudyDhadwal et al. 2007,double blind RCTNúnez-Pererira et al.2011, non-CBAGarey et al. 2008, ITSstudyQuality of study in respect to internal andexternal validity (Ranji et al. [23])Good 4Good 3Moderate 2Kato et al. 2007, non-CBA Moderate 2Wagner et al. 2011, non-CBALinam et al. 2010, casecontrolstudySchelenz et al. 2005, non-CBASharma et al. 2009, non-CBAModerate 2Moderate 2Poor 1Poor 1Quality of evidence according to theGRADE approach* [24]* Quality of evidence according to the GRADE approach: 4=high quality, 3=moderate quality, 2=low quality, 1=very low qualityN.A. = not applicable26
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