重新评估抗生素预防:对干口和手术部位感染的网络元分析的见解
Tayebe Rojhanian1, Ahmad Sofi-Mahmudi2,3, Amin Vahdati4
1Department of Community Oral Health, Faculty of Dentistry, Hormozgan University of Medical Science, Bandar Abbas, Iran. t_rojhanian@yahoo.com.
Evidence-based dentistry
|November 15, 2024
概括
口服抗生素预防 (ABP) 有效地降低了下第三 (L3M) 提取后干 (DS) 和手术部位感染 (SSI) 的风险. 然而,建议谨慎使用,考虑患者因素和抗菌素耐药性问题.
科学领域:
- 口腔和牙面部外科手术
- 基于证据的牙科.
- 药理学 药理学是指药理学的学科.
背景情况:
- 手术部位感染 (SSI) 和干 (DS) 是下第三 (L3M) 提取后的潜在并发症.
- 口服抗生素预防 (ABP) 在预防这些并发症中的作用仍然是临床辩论和研究的主题.
研究的目的:
- 系统地审查和综合来自随机临床试验 (RCT) 的证据,以确定ABP在L3M提取后预防DS和SSI的有效性.
- 评估包含的研究的偏见风险和证据质量.
主要方法:
- 在MEDLINE,Cochrane图书馆和Scopus数据库中对1999年至2021年间发表的RCT进行了系统的搜索.
- 三位审查者将PICO标准用于研究选择,重点关注健康的患者,接受了用ABP,安慰剂或不接受治疗的L3M提取.
- 数据的提取和合成包括抗生素类型,剂量和结果 (DS,SSI,不良反应),利用对对和网络元分析. 研究质量是使用Cochrane协作工具和GRADE.评估的.
主要成果:
- 在分析中包括了16个RCT.
- 聚合结果表明,ABP在L3M提取后显著降低了DS (需要治疗的数量[NNT]=25) 和SSI (NNT=18) 的发病率.
- 两项研究具有低偏差风险,但根据GRADE标准,证据的整体质量被确定为低.
结论:
- 口服抗生素预防表明,在下第三提取后,减少DS和SSI风险具有明显的益处.
- 处方决策应仔细考虑个体患者的全身状况和风险因素,以减轻抗菌素耐药性的更广泛威胁.
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