Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.5.3 continued Author Year Reference Country Study design Population characteristics Intervention/ Method (I) Control (C) Results Withdrawal Drop outs Study quality and relevance Comments Nungu 1995 [45] Sweden RCT, open multicenter Per- or subtrochanteric fracture operation. Exclusions unclear. Follow-up 4 months I: Oral cefadroxil 1 g 2 h before and 12 h after operation (n=242) C: Iv cefuroxime 1.5 g 30 min pre-op. At some centres, another 3 doses given day 1 (n=210) Deep infection I: 0/242 C: 1/210 ns All infections I: 1/242 C: 6/210 p=0.07 Drop outs or lost to follow-up not mentioned Moderate Multiple primary endpoints. Definition of deep infection inadequate. No power calculation Slobogean 2008 [13] Canada Meta-analysis of duration of prophylaxis in closed long bone fracture surgery 7 RCT (Ali 2006 [68], Buckley 1990 [10], Garcia 1991 [11], Garotta 1991 [69], Gatell 1987 [9], Karachalios 1990 [12], Liebergall 1995 [70]) I: Systemic antibiotics single preoperative dose (n=1 493) C: Systemic antibiotics multiple doses (n=2 315) Surgical site infection No difference RR 1.24 (95% CI 0.60–2.60) Moderate Southwell- Keely 2004 [6] Australia Meta-analysis of 16 RCT of antibiotic prophylaxis in closed long bone fractures Hip fracture surgery. 4 RCT comparing one dose vs multiple doses (Buckley 1990 [10], Garcia 1991 [11], Gatell 1987 [9], Karachalios 1990 [12]) 3 RCT Comparing one day vs multiple days (Garcia 1991 [11], Hedström 1987 [15], Nelson 1983 [16]) I1: Systemic antibiotics one dose (n=1 099) I2: Systemic antibiotics multiple doses for 24 h (n=623) C1: Systemic antibiotics multiple doses (n=114) C2: Systemic antibiotics >24h (n=641) Wound infection No difference I1 vs C1: OR 0.93 (95% CI 0.39–2.24) I2 vs C2: OR 1.15 (95% CI 0.58–2.25) High C = Control group; CI = Confidence interval; CT = Controlled trial; h = Hours; I = Intervention group; iv = Intravenous; ns = Non significant; OR = Odds ratio; po = per os; RCT = Randomised controlled trial; RR = Relative risk; t1/2 = Half life 292 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 293
Table 4.5.4 Open fractures antibiotics vs placebo/no antibiotics. Author Year Reference Country Study design Population characteristics Intervention/ Method (I) Control (C) Results Outcome 1 Intervention Withdrawal Drop outs Study quality and relevance Comments Gosselin 2004 [17] Cochrane review, meta-analysis of RCT Open fractures of limbs. 7 studies included whereof 2 blinded. 2 included only finger fractures, one included only gun shots I: Systemic antibiotics: (di)cloxacillin, penicillin, cefazolin, cefalotin, penicillin + streptomycin, cefradine, erythromycin (n=547) C: Placebo or no antibiotics (n=366) Wound infection Antibiotics reduced the risk of infection RR 0.41 (95% CI 0.27–0.63). Absolute risk of wound infection 49/366 (13.4%) vs 30/547 (5.5%) Not stated High Poor quality studies. The positive results were more pronounced in the only 2 good quality studies Madsen 1996 [19] Denmark RCT double blind. Power calculation included. Reject log. Tablet compliance checked Traumatic wound to hand/foot with injury of bone joint or tendon. Excluded: Bite, faecal contamination, fracture >6 h old, requiring revascularisation operation. Follow-up >3 months I1: Penicillin G 2 million units before surgical treatment followed by oral placebo (n=204) I2: Placeboinjection before surgical treatment followed by oral penicillin V 1 million U x 2 x VI (n=198) C: Placebo (n=197) Wound infection I1: 10/204 (4.9%) I2: 13/198 (6.6%) C: 20/197 (10.2%) p=0.046 I1 vs C 124/723 excluded (94 for inclusion/ exclusion criteria violations, 23 for antibiotics prophylaxis deemed necessary, 7 for protocol violation) High for the study, low for fractures 56–68% with bone lesions/fractures. Results for these not given separately Stevenson 2003 [18] United Kingdom RCT, double blind, multicenter. Includes power calculation. Oral treatment compliance checked Distal phalanx finger fractures Excluded: >12 h old, bites, on antibiotics. Observation time: 3 visits during 8 weeks or until healing I: Po flucloxacillin 500 mg x 4 for 5 days (n=98) C: Placebo (n=95) Wound infection I: 3/98 (3.1%) C: 4/95 (4.2%) ns 7 (5 “protocol violations”, 2 lost to follow-up) High Only finger fractures C = Control group; CI = Confidence interval; h = Hours; I = Intervention group; n = Number of patients; ns = Non significant; po = Per os; RCT = Randomised controlled trial; RR = Relative risk 294 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 295
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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
Page 176 and 177: Sterilisering I en stor studie frå
Page 178 and 179: Table 4.4.2 Caesarean section, anti
Page 180 and 181: Table 4.4.3 Caesarean section, comp
Page 182 and 183: Table 4.4.5 Caesarean section, mult
Page 184 and 185: Table 4.4.6 continued Author Year R
Page 186 and 187: Table 4.4.8 Hysterectomy, antibioti
Page 190 and 191: Table 4.4.10 Hysterectomy, duration
Page 192 and 193: Table 4.4.12 continued Author Year
Page 194 and 195: Table 4.4.14 Intrauterine contracep
Page 202 and 203: 15. Sullivan SA, Smith T, Chang E,
Page 204 and 205: hysterectomy. Clin Infect Dis 1995;
Page 206 and 207: urethropexy. Journal of Pelvic Medi
Page 208 and 209: 97. Mangioni C, Bianchi L, Bolis PF
Page 210 and 211: 4.5 Antibiotikaprofylax vid ortoped
Page 212 and 213: inte sällan i kronisk form. Insät
Page 214 and 215: Inklusionskriterier Enbart prospekt
Page 216 and 217: och medarbetare från år 1987 [9]
Page 218 and 219: (från 1998) samtidigt som man helt
Page 220 and 221: KAPITEL 4 • den systematiska litt
Page 222 and 223: Thomsen 1990 [44] Denmark RCT, open
Page 224 and 225: Table 4.5.3 Closed fractures; durat
Page 228 and 229: Table 4.5.5 Studies comparing diffe
Page 232 and 233: Table 4.5.7 Prosthesis, different d
Page 236 and 237: Table 4.5.9 Prosthesis and antibiot
Page 238 and 239: Table 4.5.11 Low study quality and
Page 242 and 243: prophylaxis in trochanteric hip fra
Page 244 and 245: 45. Nungu KS, Olerud C, Rehnberg L,
Page 246 and 247: 324 antibiotikaprofylax vid kirurgi
Page 248 and 249: Det är oklart om antibiotikaprofyl
Page 250 and 251: Resultat av litteratursökningen oc
Page 252 and 253: Två artiklar med medelhög kvalite
Page 254 and 255: Övrig plastikkirurgi Två artiklar
Page 256 and 257: Table 4.6.2 Skin surgery. Author Ye
Page 258 and 259: Table 4.6.3 Breast surgery. Author
Page 260 and 261: Table 4.6.4 Abdominoplasty. Author
Page 262 and 263: Referenser 1. Amland PF, Andenaes K
Page 264 and 265: 348 antibiotikaprofylax vid kirurgi
Page 266 and 267: I en del situationer görs en omede
Page 268 and 269: Bröstcancerbehandling har genomgå
Page 270 and 271: Table 4.7.2 Breast cancer operation
Page 272 and 273: 4.8 Antibiotikaprofylax vid hjärtk
Page 274 and 275: 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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Resultat av litteratursökningen oc
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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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Table 4.12.12 Low study quality and
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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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Table 4.13.9 Low study quality and
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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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