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Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant

Juliana Arruda de Matos1, Amanda da Silva Gomes2, Carla Ormundo G Ximenes Lima2

  • 1Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Rio de Janeiro, RJ, Brazil.

The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases
|October 13, 2022
PubMed
Abstract

Insights

Current guidelines lack specific strategies to prevent multidrug-resistant Gram-negative bacilli (MDR-GNB) surgical site infections (SSIs). Evidence suggests surgical antibiotic prophylaxis with aminoglycoside may reduce MDR-GNB SSIs in renal transplant recipients, but more research is needed.

Area of Science:

  • Infectious Diseases
  • Surgical Infections
  • Antimicrobial Resistance

Background:

  • Surgical site infections (SSIs) caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) lack specific preventive recommendations.
  • This systematic review evaluates measures to prevent MDR-GNB SSIs.

Approach:

  • Searched MEDLINE, EMBASE, CINAHL, and LILACS databases up to February 18, 2020.
  • Included randomized trials and observational cohort studies on preventive measures for MDR-GNB SSIs in adult surgical patients.
  • Evaluated study quality using Newcastle-Ottawa, ROBINS-I, and GRADE methods; performed random-effects meta-analyses.

Key Points:

  • Identified 10,663 titles; included 3 studies (2 retrospective, 1 prospective).
  • Meta-analysis of 2 renal transplantation studies (854 patients) showed a relative risk of 0.57 (95%CI: 0.25-1.34) for MDR-GNB SSI with surgical antibiotic prophylaxis (SAP) including aminoglycoside (GRADE: moderate).
  • One study evaluated ertapenem vs. cephalosporin plus metronidazole for SAP in extended-spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery.

Conclusions:

  • Insufficient data currently support specific measures against MDR-GNB SSIs.
  • Prospective, randomized studies are essential to confirm the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention in renal transplant recipients and other patient groups.
Keywords:
Drug resistance, multipleGram-negative bacterial infectionsInfection controlSurgical wound infectionSystematic review

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