Abstract：
BACKGROUND: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease.
METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool.
RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as \'very low,\' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups.
CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool.
RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as \'very low,\' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups.
CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
摘要：
背景：预防意外接触布鲁氏菌后的布鲁氏菌病是公共卫生领域的重要课题。本研究旨在系统评价意外接触布鲁氏菌后预防抗生素预防人类布鲁氏菌病的功效。
方法：研究方案在PROSPERO（CRD42023456812）中注册。结果包括布鲁氏菌病的发病率，不良事件发生率，和抗生素预防依从性。全面的文献检索，一直持续到11月20日，2023年，涉及Medline，Embase,科克伦图书馆,和LILACS数据库。使用R软件进行描述性分析和荟萃分析，使用JBI关键评估工具评估偏差风险，使用GRADE工具评估证据的确定性。
结果：在最初确定的3102条记录中，八项研究涉及97个人意外暴露，所有这些都集中在实验室环境中意外接触布鲁氏菌的高风险，包括在审查中。所有研究都报道了包含多西环素的预防性治疗，剂量为100毫克，每天两次，结合600毫克的利福平，两者均超过21天。86％的病例报告了预防依从性，治疗后布鲁氏菌病的发病率为0.01。不良事件,主要是胃肠,发生在26％的病例中。严格的评估揭示了报告人口统计学和临床信息的局限性。证据的确定性被评为非常低，由于研究设计的限制和缺乏比较组，强调在解释观察到的结果时需要谨慎。
结论：PEP是文献中报道的替代实践，用于高风险接触布鲁氏菌的事故。目前可用的抗生素预防功效的证据不足以支持支持或反对广泛使用抗生素预防的建议。因此，由于证据的确定性非常低，在解释结果时需要谨慎，主要源于病例系列和缺乏比较组。
方法：研究方案在PROSPERO（CRD42023456812）中注册。结果包括布鲁氏菌病的发病率，不良事件发生率，和抗生素预防依从性。全面的文献检索，一直持续到11月20日，2023年，涉及Medline，Embase,科克伦图书馆,和LILACS数据库。使用R软件进行描述性分析和荟萃分析，使用JBI关键评估工具评估偏差风险，使用GRADE工具评估证据的确定性。
结果：在最初确定的3102条记录中，八项研究涉及97个人意外暴露，所有这些都集中在实验室环境中意外接触布鲁氏菌的高风险，包括在审查中。所有研究都报道了包含多西环素的预防性治疗，剂量为100毫克，每天两次，结合600毫克的利福平，两者均超过21天。86％的病例报告了预防依从性，治疗后布鲁氏菌病的发病率为0.01。不良事件,主要是胃肠,发生在26％的病例中。严格的评估揭示了报告人口统计学和临床信息的局限性。证据的确定性被评为非常低，由于研究设计的限制和缺乏比较组，强调在解释观察到的结果时需要谨慎。
结论：PEP是文献中报道的替代实践，用于高风险接触布鲁氏菌的事故。目前可用的抗生素预防功效的证据不足以支持支持或反对广泛使用抗生素预防的建议。因此，由于证据的确定性非常低，在解释结果时需要谨慎，主要源于病例系列和缺乏比较组。
