术后抗生素预防皮肤穿透性利切除术和感染风险:系统性审查和元分析
Thalita Bento Talizin1, Alexandre Danilovic1,2, Fabio Cesar Miranda Torricelli3
1Hospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, Brasil.
概括
经过皮肤瘤切除术 (PCNL) 后的长期术后抗生素使用并不能降低败血症或发烧的风险. 抗生素预防应仅限于在PCNL手术中诱导麻醉.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 传染性疾病 传染性疾病
- 基于证据的医学基于证据的医学.
背景情况:
- 穿皮石切除术 (PCNL) 是一种常见的石切除手术.
- 在PCNL后抗生素预防的最佳持续时间仍在争论中.
- 这一元分析评估了延长术后抗生素在预防并发症方面的疗效.
研究的目的:
- 对随机对照试验 (RCT) 进行高质量的元分析.
- 评估延长术后抗生素预防与PCNL患者单剂量预防的疗效.
- 澄清术后抗生素在预防PCNL后并发症中的作用.
主要方法:
- 在EMBASE,PubMed和科学网络中对RCT进行系统的文献搜索,直到2023年5月.
- 使用的PICO框架:人口 (PCNL患者),干预 (扩展抗生素),控制 (单剂量抗生素),结果 (SIRS/败血症,发烧).
- 使用随机效应模型来计算几率比率 (OR) 和95%置信区间 (CI) 的元分析.
主要成果:
- 包括7个RCT,包括629名患者.
- 在延长术后抗生素和减少SIRS/败血症 (OR 1.236,p=0.429) 之间没有发现统计学意义上的关联.
- 长时间使用抗生素后,术后发烧没有显著降低 (OR2.049,p=0.140).
结论:
- 目前的证据不支持PCNL在麻醉诱导之外的延长术后抗生素预防的常规使用.
- 将抗生素预防限制在外科手术前期可能足够,并避免潜在的过度使用.
- 进一步的研究可以探索可能从延长预防中受益的特定患者亚组.
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