Antibiotikaprofylax vid kirurgiska ingrepp - SBU

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Table 4.14.4 Implant surgery. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Esposito 2008 [24] Italy RCT Pts who had implant treatment. Placebo controlled. Blinded I: Amoxicillin 2 x 1 g po. Chlorhexidin mouthwashes 0.2% x 2 x 7 (n=158) C: Placebo 2 x 1 g po. Chlorhexidin mouth-washes 0.2% x 2 x 7 (n=158) Prosthesis failure I: 2/158 C: 4/158 Implant failure I: 2/158 C: 8/158 SSI I: 9/158 C: 12/158 14 pts (7+7). Described Moderate Included in Esposito 2008 (Cochrane) [1]. Although power was estimated there is a risk that the study was underpowered Side effects I: 1/158 C: 1/158 Esposito 2008 [1] Systematic review Cochrane Library Antibiotic prophylaxis at dental implant surgery 2 RCT I1: Amoxicillin 2 g po pre-op I2: Amoxicillin 2 g po (should be 1 g) pre-op + 500 mg x 4 x 2 days n=198 C1: Placebo C2: No antibitics n=198 Implant failure I: 2 implant C: 8 implant RR 0.22 (95% CI 0.06–0.86) 14 pts reason given Moderate Systematic review of high quality. Only 2 studies, underpowered, 1 not blinded. Wrong reference to dose of amoxicillin in 1 study C = Control group; CI = Confidence interval; I = Intervention group; po = Per os; pts = Patients; RCT = Randomised controlled trial; RR = Relative risk; SSI = Surgical site infection 544 antibiotikaprofylax vid kirurgiska ingrepp KAPITEL 4 • den systematiska litteraturöversikten 545
Table 4.14.5 Jaw fractures. Author Year Reference Country Study design Population characteristics Intervention Method Number individuals Control Number individuals Results Withdrawal Drop outs Study quality and relevance Comments Andreasen 2006 [25] Denmark Systematic review Antibiotic prophylaxis in surgical treatment of jaw fractures. 6 ingoing RCT studies. 603 pts. 4 studies intervention vs no treatment. 2 studies concerning different antibiotic period I1: 4 studies. Different antibiotic regimens and short and long prophylaxis. Untreated controls (n=300) I2: 2 studies. One (14+16 pts) placebo controlled. Short term prophylaxis (n=120) C1: Placebo or no antibiotics Number unclear since not stated in 1 paper cited C2: Long term prophylaxis SSI I1: 21/300 pts C1: 53/151 pts I2: 2/45 pts C2: 2/45 pts Not stated in all papers High Systematic review of high quality, but ingoing studies of low or moderate quality Chole 1987 [2] USA RCT Pts with facial fractures were randomised to antibiotic prophylaxis or no prophylaxis. n=101 I: Cefazolin 1 g iv 1 h before surgery (n=56) C: No antibiotic before surgery. No placebo (n=45) SSI I: 5 /56 pts C: 19/45 pts p=0.0001 No withdrawals Moderate Open study without placebo. However clear difference between intervention and control. In review by Andresen [25] Gerlach 1988 [3] Germany RCT Open study Pts treated for mandibular fracture(s) with miniplates. Inclusion and exclusion criteria defined. Randomised to prophylaxis or control. n=200 I1: 6 g mezlocillin/oxcacillin 0.5 h pre-op + every 8 h x 2 (n=50) I2: 6 g mezlocillin/oxcacillin (n=50) I3: 6 g mezlocillin/oxcacillin + 0.5 h pre-op every 8 h x 8 (n=51) C: No antibiotic prophylaxis (n=49) SSI I1: 1/50 I2: 3/50 I3: 4/51 ns C: 11/49 I vs C 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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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
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
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Page 390 and 391: Table 4.13.6 Rhinosurgery. Author Y
Page 392 and 393: Table 4.13.9 Low study quality and
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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 414 and 415: Table 4.14.6 Other dentoalveolar su
Page 416 and 417: Table 4.14.8 Low quality and releva
Page 418 and 419: Table 4.14.8 continued Author Year
Page 420 and 421: Referenser 1. Esposito M, Grusovin
Page 422 and 423: preoperative single-dose clindamyci
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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
Page 436 and 437: frekvensen postoperativa sårinfekt
Page 438 and 439: 6. Etiska aspekter Infektioner rela
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Page 442 and 443: • Hur garanterades bästa möjlig
Page 444 and 445: Etisk analys med hjälp av aktörsm
Page 446: Referens 1. Hermerén G. Kunskapens
Page 449 and 450: Granskningen av hälsoekonomisk lit
Page 451 and 452: Distala Duodenum E Coli ”Efficien
Page 453 and 454: KNS Kolecystektomi Kolecystit Koled
Page 455 and 456: Preoperativa Protesendokoardit Pseu
Page 458 and 459: 9. Projektgrupp, externa granskare,
Page 460 and 461: 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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