Antibiotikaprofylax vid kirurgiska ingrepp - SBU

Table 4.8.5 continued
Author
Year
Reference
Country
Study
design
Population
characteristics
Intervention
Method
Number individuals
Control
Number
individuals
Results
Withdrawal
Drop outs
Study quality
and relevance
Comments
Segers
2006
[43]
The Netherlands
RCT
All pts undergoing
sternotomy in elective
cardio thoracic surgery.
Study period 2 years –
954 pts. 1 200 carciac
operations annually.
Power calculation:
990 pts. Defined
infecitons.
Follow-up 30 days
I: 0.12% chlorhexidine
gluconate solution as oral
rinse and as gel for nasal
application. Oral rinse 10 mL
for 30 seconds. 4 x days. Nose
ointment applied 4 x days in
both nostrils until nasogastric
tube was removed (usually
within 24 h post-op). Nose
cultures taken. Cefuroxime
1.5 g iv 30 min before incision
another dose if op >4 h continued
for 24 h
C: Placebo locally
and iv as above
Overall incidence of
nosocomial infection
I: 96 pts (19.8%)
(116 infections)
C: 123 pts (26.2%)
(164 infections)
ARR 6.4%
(95% CI 1.1–11.7)
p=0.002
LRTI
ARR 6.5%
(95% CI 2.3–10.7)
p=0.002
14 in active
(other ab) and
13 in control
Moderate
Decontamination
of naso- and oropharynx
reduces
infections in cardiac
surgery patients
Deep SSI
ARR 3.2%
(95% CI 0.9–5.5)
p=0.002
Usry
2002
[44]
USA
Prospective
chart study
CABG 1 200 operations/
year
I: Before operation: Intranasal
ointment (mupirocin calcium
2%) 48h and post-op in total
5 days
C: Sternal SSI rates
were compared with
those published by
the Centres for
Disease Control
Superficial sternal
wound infection
I: 1.24% (15/1 205)
C: 2.62% (68/2 595)
Deep sternal
wound infection
I: 0.75% (9/1 205)
C: 1.66% (43/2 595)
94 % had
prophylaxis
Moderate
Historical controls
Vander Salm
1989
[18]
USA
RCT
All pts of 3 surgeons
undergoing heart
surgery with median
sternotomy.
Follow-up 30 days
I: Iv cefazolin (in total 42 pts
with suspected penicillin allergy
vancomycin) for 36 h.
Odd-numbered medical record
= hemostatic mixture + 250 mg
powdered vancomycin
C: Iv cefazolin (in
total 42 pts with
suspected penicillin
allergy vancomycin)
for 36 h. Evennumbered
medical
record=hemostatic
mixture
Sternal wound infection
I: 1 pt (0.45%)
C: 7 pts (3.6%)
p=0.02
Moderate
Antibiotic resistance
not noted
C = Control group; CABG = Coronary artery bypass graft; CI = Confidence interval;
I = Intervention group; iv = Intravenous; h = Hour; LRTI = Lower respiratory tract
infection; OR = Odds ratio; pts = Patients; RCT = Randomised controlled trial
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