背景:手术部位感染(SSI)是手部手术最常见的早期并发症。然而,在手部和上肢的选择性清洁软组织手术中,抗生素预防的适应症仍然不确定。因此,我们对文献进行了系统综述,并进行了荟萃分析,以研究在这些类型的手术中预防性使用抗生素对预防SSI的影响.
方法:在以下数据库中进行了电子搜索:MEDLINE/Pubmed,PMC/Pubmed,WebofScience/ClarivateAnalytics,Embase/Elsevier,Scopus/Elsevier,BVS/丁香花,还有Cochrane图书馆,没有关于出版语言或日期的限制。感兴趣的主要结果是在术前抗生素预防和无抗生素预防的情况下,手和上肢的选择性清洁软组织手术后发生SSI。排除了同时进行骨骼手术或骨科植入物的手术。研究选择和数据提取由两名评审员独立进行。RoB2.0和ROBINS-I是Cochrane偏倚风险工具,用于干预措施的随机试验和非随机研究。使用相对风险(RR)估计干预效果的大小。使用ReviewManager和R软件工具进行荟萃分析,使用Mantel-Haenszel随机效应模型和95%置信区间(CI)。p≤0.05的结果被认为具有统计学意义。使用建议分级评估证据质量,评估,发展,和评估(等级)方法。
结果:最初的搜索产生了1175个标题,其中12篇文章符合系统评价的纳入标准,10例纳入随后的荟萃分析.这些研究大多是非随机干预试验,表现出中等的偏见风险。根据我们的审查,术前预防使用抗生素对SSI的发生率无统计学意义(RR=1.13,95%CI0.91~1.40,p=0.28).该结果的总体证据质量被评为较低。观察到中度统计异质性(I2=44%),预设的敏感性分析强调了结果的一致性。
结论:虽然这些结果与本综述中的个别研究的结果一致,重要的是要注意,考虑到P≤0.05的阈值有统计学意义,从获得的数据的定量分析中无法得出明确的结论。
方法:二级。
背景:CRD42023417786。
BACKGROUND: Surgical site infections (SSI) are the most frequent early complications of hand surgeries. However, the indications still remain uncertain for antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb. Therefore, a systematic
review of the literature and a meta-analysis was conducted to investigate the impact of antibiotic prophylaxis on the prevention of SSI in these types of surgeries.
METHODS: An electronic search was performed in the following databases: MEDLINE/Pubmed, PMC/Pubmed, Web of Science/Clarivate Analytics, Embase/Elsevier, Scopus/Elsevier, BVS/Lilacs, and the Cochrane Library, with no restrictions regarding publication language or date. The primary outcome of interest was the occurrence of SSI following elective clean soft tissue surgeries of the hand and upper limb according to the administration of preoperative antibiotic prophylaxis and no antibiotic prophylaxis. Surgeries involving simultaneous bone procedures or orthopedic implants were excluded. Study selection and data extraction were conducted independently by two reviewers. RoB 2.0 and ROBINS-I are Cochrane risk-of-bias tool for randomized trials and non-randomized studies of interventions. The magnitude of the intervention effect was estimated using the relative risk (RR). The meta-analysis was performed with the
Review Manager and R software tools, using the Mantel-Haenszel random-effects model and a 95% confidence interval (CI). Results with p ≤ 0.05 were considered statistically significant. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS: The initial search yielded 1175 titles, from which 12 articles met the inclusion criteria for the systematic
review, and 10 were included in the subsequent meta-analysis. The majority of these studies were nonrandomized intervention trials, exhibiting a moderate risk of bias. According to our
review, preoperative antibiotic prophylaxis did not have a statistically significant impact on the incidence of SSI (RR = 1.13, 95% CI 0.91-1.40, p = 0.28). The overall quality of evidence for this outcome was rated as low. Moderate statistical heterogeneity was observed (I2 = 44%), and the prespecified sensitivity analysis highlighted the consistency of the results.
CONCLUSIONS: While these results were consistent with the findings from individual studies included in this
review, it is important to note that, given the threshold of p ≤ 0.05 for statistical significance, no definitive conclusions can be drawn from the quantitative analysis of the data obtained.
METHODS: Level 2.
BACKGROUND: CRD42023417786.