Efficacy of prophylactic antibiotic therapy in spinal surgery: A meta-analysis
Efficacy of prophylactic antibiotic therapy in spinal surgery: A meta-analysis
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DOI：
10.1097/00006123-200208000-00017
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发表时间：
2002-08-01
期刊：
影响因子：
4.8
通讯作者：
Barker, FG
中科院分区：
文献类型：
--
作者：
Barker, FG
目的：在脊柱手术中使用预防性抗生素治疗的实践中存在相当大的差异。迄今为止，个别研究尚未证明脊柱手术中预防性抗生素治疗具有显着益处。方法：对脊柱手术、普通神经外科和骨科手术中预防性抗生素治疗的随机前瞻性试验进行系统数据库搜索。对治疗获益与基线感染率和其他试验特征进行随机效应荟萃分析和贝叶斯荟萃回归。结果：确定了 6 项前瞻性随机试验或试验亚组，共纳入 843 名患者，即 1 项脊柱手术试验、4 项普通神经外科试验和 1 项普通骨科手术试验。没有个别试验表明预防性抗生素治疗对脊柱手术患者具有统计学上的显着效果。使用抗生素时的原始合并感染率为 2.2%（451 名患者中的 10 名），未使用抗生素时的原始合并感染率为 5.9%（392 名患者中的 23 名）。个别试验感染率范围为 1.2% 至 8.5%。合并比值比为 0.37（95% 置信区间，0.17-0.78），有利于抗生素治疗（P < 0.01）。试验之间的治疗效果没有显着异质性。贝叶斯元回归用于测试抗生素在基线感染率较低的试验中是否效果较差，以及是否可以确定最佳抗生素治疗方案。在基线感染率较低的试验中、在覆盖革兰氏阳性菌的基础上使用覆盖革兰氏阴性菌的抗生素的试验中、或者在使用多剂量与单剂量方案的试验中，抗生素治疗效果没有显着差异。脊柱手术中抗生素治疗的非随机研究比随机试验得出了更高的治疗效果估计值，但并不显着。 结论：预防性抗生素治疗对脊柱手术是有益的，即使不使用抗生素治疗的预期感染率较低。
OBJECTIVE: There is considerable variation in practice regarding the use of prophylactic antibiotic therapy in spinal operations. To date, individual studies have not demonstrated a significant benefit for prophylactic antibiotic therapy in spinal operations.METHODS: Systematic database searches for randomized prospective trials of prophylactic antibiotic therapy in spinal surgery, general neurosurgery, and orthopedic surgery were performed. Random-effects meta-analysis and Bayesian meta-regressions of treatment benefits versus baseline infection rates and other trial characteristics were performed.RESULTS: Six prospective randomized trials or trial subgroups, enrolling 843 patients, were identified, i.e., one spinal surgery trial, four general neurosurgery trials, and one general orthopedic surgery trial. No individual trial demonstrated a statistically significant effect of prophylactic antibiotic therapy for spinal surgery patients. Raw pooled infection rates were 2.2% (10 of 451 patients) with antibiotics and 5.9% (23 of 392 patients) without antibiotics. Individual trial infection rates ranged from 1.2 to 8.5%. The pooled odds ratio was 0.37 (95% confidence interval, 0.17-0.78), favoring antibiotic treatment (P < 0.01). There was no significant heterogeneity in treatment efficacy among the trials. Bayesian meta-regression was Used to test whether antibiotics were less effective in trials with low baseline infection rates and whether an optimal antibiotic regimen could be identified. There was no significant difference in antibiotic treatment effects in trials with lower baseline infection rates, in trials using antibiotics with gram-negative coverage in addition to gram-positive coverage, or,in trials using multiple-dose versus single-dose regimens. Nonrandomized studies of antibiotic therapy in spinal surgery yielded greater treatment effect estimates than did randomized trials, but not significantly so.CONCLUSION: Prophylactic antibiotic therapy is beneficial for spinal surgery, even when expected infection rates without antibiotic treatment are low.