Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.13.5 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 Johnson 1984 [4] USA RCT Double blind Major oncological surgery of the head and neck in which the upper aero digestive tract was to be entered through a cervical incision. n=80 I1: Cefoperazone sodium 2 g, initial dose given 1 h before surgery, and then 3 doses every 8 h (n=39) I2: Cefotaxime sodium 2 g every 8 h (n=32) C: Placebo (n=9) Wound infections I1: 4 (10.24%) I2: 3 (9.4%) C: 7 (78%) I1, I2 vs C p
Table 4.13.5 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 Righi 1996 [8] Italy RCT Cancer of the oral cavity, pharynx or larynx. n=174 enrolled (n=162, 20 female, 142 men) I: Clindamycin 600 mg iv followed by 3 doses and cefonicid 1 g iv at induction and 1 g after 12 h for 1 day (n=81) C: Clindamycin 600 mg iv followed by 3 doses and cefonicid 1 g iv at induction and 1 g after 12 h for 3 days (n=81) Wound infections I: 2 (5%) C: 3 (7%) p>0.05 12 excluded Moderate Excluded. Blinding not described those who recieved antibiotics prior to surgery and suspected hypersensitivity Robbins 1988 [10] USA RCT Double blind Oncologic contaminated and cleancontaminated procedures of the head and neck, clean procedures that involved extensive exposure of the operating field or the use of skin grafts or flaps. n=381 I: Cefazolin 1 g iv 1 h pre-operatively + 500 mg iv every 8 h x 6, metronidazole 500 mg iv 1 h pre-operatively and 250 mg iv every 8 h for 6 doses (n=158) C: Cefazolin 1 g iv 1 h pre-operatively + 500 mg iv every 8 h x 6 (n=172) Wound infections I: 34 (9.5%) C: 65 (18.6%) p=0.03 51 Moderate Rodrigo 1997 [11] Spain RCT Double blind Oncologic surgery involving a cleancontaminated wound Female/male: 4/155 Mean age: 59.5 years. n=175 I1: Amoxicillin-clavulanate 2 g iv started before surgery and additional 3 doses (n=57) I2: Clindamycin 600 mg + gentamicin 80 mg started before surgery and additional 3 doses (n=52) C: Cefazolin 2 g started before surgery and additional 3 doses of 1 g (n=50) Wound infections I1: 22.8% I2: 21.2% C: 26% p=0.8 16 Moderate Excluded allergic, recent antibiotics, and those with flap reconstruction. High infection rates overall, 23%. 159 pts considered evaluable Swanson 1991 [12] USA RCT Double blind Major oncologic head and neck surgery during which a cervical skin incision was used to remove a tumor of the upper aero digestive tract, completed within 6 h. n=108 I: Clindamycin 600 mg iv given 1–2 h before surgery and continued every 8 h for a total of 4 doses (n=49) C: Cefonicid 1 g given 1–2 h pre-operatively following placebo every 8 h for a total of 4 doses (n=50) Wound infections I: 4 (8.2%) C: 12 (24%) p
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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
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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 4.4.14 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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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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Page 338 and 339: är fastställd. I en undersökning
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Page 346 and 347: Table 4.12.3 Cystoscopy. Author Yea
Page 348 and 349: Table 4.12.4 Transrectal prostatic
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Page 354 and 355: Table 4.12.6 Transurethral resectio
Page 356 and 357: Table 4.12.8 Extracorporeal Shockwa
Page 360 and 361: Table 4.12.10 Percutaneous nephroli
Page 362 and 363: Table 4.12.12 Low study quality and
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Page 384 and 385: Table 4.13.3 Tonsillectomy. Author
Page 386 and 387: Table 4.13.5 Cancer. Author Year Re
Page 390 and 391: Table 4.13.6 Rhinosurgery. Author Y
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Page 408 and 409: Table 4.14.2 Third molar surgery. A
Page 410 and 411: Table 4.14.3 Orthognatic surgery. A
Page 412 and 413: Table 4.14.4 Implant surgery. Autho
Page 414 and 415: Table 4.14.6 Other dentoalveolar su
Page 416 and 417: Table 4.14.8 Low quality and releva
Page 420 and 421: Referenser 1. Esposito M, Grusovin
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Page 430 and 431: Table 4.15.1 Antibiotic prophylaxis
Page 432 and 433: Table 4.15.2 Antibiotic prophylaxis
Page 434 and 435: 5. Infektionsprofylax utan antibiot
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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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