Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-30T20:21:24.326Z Has data issue: false hasContentIssue false
  • English
  • Français

Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials

Published online by Cambridge University Press:  12 November 2018

Sumanth Gandra ,
Anna Trett ,
Gerardo Alvarez-Uria ,
Joseph S. Solomkin  and
Ramanan Laxminarayan Open the ORCID record for Ramanan Laxminarayan [Opens in a new window]
Sumanth Gandra
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom
Anna Trett
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom
Gerardo Alvarez-Uria
Affiliation:
Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, AP, India
Joseph S. Solomkin
Affiliation:
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Ramanan Laxminarayan*
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom Princeton Environmental Institute, Princeton, New Jersey, United States
*
Author for correspondence: Ramanan Laxminarayan PhD, MPH, 1400 Eye St NW, Suite 500, Washington, DC 20005. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Rising antibiotic resistance could reduce the effectiveness of antibiotics in preventing postoperative infections. We investigated trends in the efficacy of antibiotic prophylaxis regimens for 3 commonly performed surgical procedures—appendectomy, cesarean section, and colorectal surgery—and 1 invasive diagnostic procedure, transrectal prostate biopsy (TRPB).

Design

Systematic review and meta-analysis.

Methods

We searched PubMed and Cochrane databases (through October 31, 2017) for randomized control trials (RCTs) that measured the efficacy of antibiotic prophylaxis for 4 index procedures in preventing postoperative infections (surgical site infections [SSIs] following the 3 surgical procedures and a combination of urinary tract infections [UTIs] and sepsis following TRPB).

Results

Of 399 RCTs, 74 studies (9 appendectomy, 11 cesarean section, 39 colorectal surgery, and 15 TRPB) were included. Multilevel logistic regression models with random intercepts for each study showed no statistically significant increase in SSIs over time for appendectomy (adjusted odds ratio [aOR] per year, 1.03; 95% confidence interval [CI], 0.92–1.16; P=.57), cesarean section (aOR per year, 1.01; 95% CI, 0.96–1.05; P=.80), and TRPB (aOR per year, 0.95; 95% CI, 0.77–1.18; P=.67). However, there was a significant increase in SSIs proportion following colorectal surgery (aOR per year, 1.049; 95% CI, 1.03–1.07; P<.001).

Conclusion

The efficacy of antibiotic prophylaxis agents in preventing SSIs following colorectal surgery has declined. Small number of RCTs and low infections rates limited our ability to assess true effect for simple appendectomy, cesarean section, or TRPB.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 133 - 141
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

Cite this article: Gandra S, et al. (2019). Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials. Infection Control & Hospital Epidemiology 2019, 40, 133–141. doi: 10.1017/ice.2018.295

References

1. Bowater, RJ, Stirling, SA, Lilford, RJ. Is antibiotic prophylaxis in surgery a generally effective intervention? Testing a generic hypothesis over a set of meta-analyses. Ann Surg 2009;249:551–556.Google Scholar
2. Gafter-Gvili, A, Fraser, A, Paul, M, et al. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Revs 2012;1:CD004386.Google Scholar
3. Smith, R, Coast, J. The true cost of antimicrobial resistance. BMJ 2013;346:f1493.Google Scholar
4. Teillant, A, Gandra, S, Barter, D, Morgan, DJ, Laxminarayan, R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis 2015;15:1429–1437.Google Scholar
5. Anderson, DJ, Podgorny, K, Berrios-Torres, SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:S66–S88.Google Scholar
6. Kirby, A, Santoni, N. Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery? J Hosp Infect 2015;89:259–263.Google Scholar
7. Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect 2013;14:73–156.Google Scholar
8. Andersen, BR, Kallehave, FL, Andersen, HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev 2003;2:CD001439.Google Scholar
9. Smaill, FM, Gyte, GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2010:CD007482. Google Scholar
10. Nelson, RL, Glenny, AM, Song, F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2009;1:CD001181.Google Scholar
11. Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784–791.Google Scholar
12. Higgins, JP, Altman, DG, Gøtzsche, PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.Google Scholar
13. Nyaga, VN, Arbyn, M, Aerts, M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Pub Health 2014;72:39.Google Scholar
14. DerSimonian, R, Laird, N. Meta-analysis in clinical trials. Control Clin Trial 1986;7:177–188.Google Scholar
15. Hamza, TH, van Houwelingen, HC, Stijnen, T. The binomial distribution of meta-analysis was preferred to model within-study variability. J Clin Epidemiol 2008;61:41–51.Google Scholar
16. Bauer, T, Vennits, B, Holm, B, et al. Antibiotic prophylaxis in acute nonperforated appendicitis. The Danish Multicenter Study Group III. Ann Surg 1989;209:307.Google Scholar
17. Morris, WT, Innes, DB, Richardson, RA, Lee, AJ, Ellis‐Pegler, RB. The prevention of post‐appendicectomy sepsis by metronidazole and cefazolin: a controlled double blind trial. Austral NZ J Surg 1980;50:429–433.Google Scholar
18. Winslow, RE, Dean, RE, Harley, JW. Acute nonperforating appendicitis: efficacy of brief antibiotic prophylaxis. Arch Surg 1983;118:651–655.Google Scholar
19. Buckels, JA, Brookstein, R, Bonser, R, Bullen, B, Alexander-Williams, J. A comparison of the prophylactic value of cefotetan and metronidazole in appendectomy. World J Surg 1985;9:814–817.Google Scholar
20. Liberman, MA, Greason, KL, Frame, S, Ragland, JJ. Single-dose cefotetan or cefoxitin versus multiple-dose cefoxitin as prophylaxis in patients undergoing appendectomy for acute nonperforated appendicitis. J Am Coll Surg 1995;180:77–80.Google Scholar
21. Lang, S, Morris, A, Charlesworth, P. Prophylaxis in appendicectomy with cefoxitin or ceftriaxone. NZ Med J 1988;101:781–783.Google Scholar
22. O’Rourke, MG, Wynne, JM, Morahan, RJ, Green, AJ, Walker, RM, Wilson, ME. Prophylactic antibiotics in appendicectomy: a prospective double blind randomized study. Austral NZ J Surg 1984;54:535–541.Google Scholar
23. Salam, I, Galala, KA, El Ashaal, Y, Chandran, VP, Asham, N, Sim, A. A randomized prospective study of cefoxitin versus piperacillin in appendicectomy. J Hosp Infect 1994;26:133–136.Google Scholar
24. Kang, SH, Kim, SW, Jo, IH, et al. Prospective clinical study of prophylactic antibiotic therapy in nonperforated appendicitis. J Korean Surg Soc 2000;58:824–833.Google Scholar
25. Fugere, P, Turgeon, P, Boucher, M, Verschelden, G, Lemay, M. Use of cephalosporins as antibiotic prophylaxis in cesarean section. Canad Med Assoc J 1983;129:132–135.Google Scholar
26. Witt, A, Döner, M, Petricevic, L, et al. Antibiotic prophylaxis before surgery vs after cord clamping in elective cesarean delivery: a double-blind, prospective, randomized, placebo-controlled trial. Arch Sur 2011;146:1404–1409.Google Scholar
27. Kandil, M, Sanad, Z, Gaber, W. Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting. J Maternal-Fetal Neonat Med 2014;27:588–591.Google Scholar
28. Macones, GA, Cleary, KL, Parry, S, et al. The timing of antibiotics at cesarean: a randomized controlled trial. Obstet Gynecol Surv 2012;67:453–454.Google Scholar
29. Mivumbi, VN, Little, SE, Rulisa, S, Greenberg, JA. Prophylactic ampicillin versus cefazolin for the prevention of post‐cesarean infectious morbidity in Rwanda. Int J Gynecol Obstet 2014;124:244–247.Google Scholar
30. Rayburn, W, Varner, M, Galask, R, Petzold, C, Piehl, E. Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section. Antimicrob Agent Chemother 1985;27:337–339.Google Scholar
31. Sullivan, SA, Smith, T, Chang, E, Hulsey, T, Vandorsten, JP, Soper, D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol 2007;196:455. e451–e455.Google Scholar
32. Thigpen, BD, Hood, WA, Chauhan, S, et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol 2005;192:1864–1868.Google Scholar
33. Wax, JR, Hersey, K, Philput, C, et al. Single dose cefazolin prophylaxis for postcesarean infections: before vs. after cord clamping. J Matern‐Fetal Med 1997;6:61–65.Google Scholar
34. Yildirim, G, Gungorduk, K, Guven, HZ, et al. When should we perform prophylactic antibiotics in elective cesarean cases? Arch Gynecol Obstet 2009;280:13–18.Google Scholar
35. Jyothirmayi, CA, Halder, A, Yadav, B, Samuel, ST, Kuruvilla, A, Jose, R. A randomized controlled double blind trial comparing the effects of the prophylactic antibiotic, cefazolin, administered at caesarean delivery at two different timings (before skin incision and after cord clamping) on both the mother and newborn. BMC Preg Childbirth 2017;17:340.Google Scholar
36. Anders, A, Nordhausen, B, Zeuschner, Z, Fabrizius, K. Prevention of infections in surgery of the colon. Zentralblatt fur Chirurgie 1984;109:1097–1106.Google Scholar
37. Antonelli, W, Borgani, A, Machella, C, et al. Comparison of two systemic antibiotics for the prevention of complications in elective colorectal surgery. Ital J Surg Sci 1985;15:255–258.Google Scholar
38. Armengaud, F, Jobard, J, Bernard, E, et al. Single dose antibiotic prophylaxis in colorectal surgery: Cefoxitine versus piperacillin. A randomized, double-blind study in 60 patients. Presse Medicale 1986;15:2351–2352.Google Scholar
39. Cainzos, M, Potel, J, Puente, J. Short-term antibiotic prophylaxis in colorectal surgery: a comparative study of gentamicin plus clindamycin vs cefoxitin. Acta Therapeutica 1986;12:399–412.Google Scholar
40. Coppa, GF, Eng, K, Gouge, TH, Ranson, JH, Localio, SA. Parenteral and oral antibiotics in elective colon and rectal surgery: a prospective, randomized trial. Am J Surg 1983;145:62–65.Google Scholar
Supplementary material: File

Gandra et al. supplementary material

Gandra et al. supplementary material 1

Download Gandra et al. supplementary material(File)
File 65.5 KB
Supplementary material: File

Gandra et al. supplementary material

Gandra et al. supplementary material 2

Download Gandra et al. supplementary material(File)
File 50 KB
Supplementary material: File

Gandra et al. supplementary material

Gandra et al. supplementary material 3

Download Gandra et al. supplementary material(File)
File 49.1 KB