背景:庆大霉素已被越来越多地代替头孢菌素用于手术预防,以试图降低“艰难梭菌”感染率。关于这些患者中与庆大霉素相关的肾毒性的数据有限。
方法:我们进行了系统综述和荟萃分析,以评估含庆大霉素的手术预防方案中急性肾损伤(AKI)的风险,与不含庆大霉素的方案相比,在几种类型的手术中。使用PubMed和Embase进行电子搜索,包括“AKI”的术语,庆大霉素,和具有和不具有MeSH/EMTREE功能的手术预防。然后使用随机效应模型进行统计分析;风险比(RR),计算风险差异(RD)和异质性(I2)。漏斗图用于评估发表偏倚。
结果:11项研究包括15个队列,18,354名患者纳入分析。根据手术类型进行亚组分析。我们发现,含庆大霉素的抗生素预防方案在骨科手术中具有发生术后AKI的显着风险(RR2.99;95%CI:1.84,4.88)。结果在其他类型的手术中尚无定论。漏斗图表明潜在的出版偏差。
结论:庆大霉素诱导的AKI在骨科手术患者中具有重要意义。医师应考虑在个别患者中使用该方案的风险和益处。
BACKGROUND: Gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of \"Clostridium difficile\" infection. There are limited data regarding nephrotoxicity related to gentamicin in these patients.
METHODS: We have conducted a systematic
review and meta-analysis to evaluate the risk of acute kidney injury (AKI) in gentamicin-containing surgical prophylactic regimens, compared to regimens without gentamicin, in several types of surgery. Electronic searches were performed using PubMed and Embase, including terms for \"AKI, gentamicin, and surgical prophylaxis\" with and without MeSH/EMTREE functions. Statistical analysis was then performed using a random-effect model; risk ratios (RR), risk differences (RD) and heterogeneity (I2) were calculated. Funnel plot was used for assessment of publication bias.
RESULTS: Eleven studies with fifteen cohorts with 18,354 patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias.
CONCLUSIONS: Gentamicin-induced AKI is significant in patients undergoing orthopedic surgery. Physicians should consider risks and benefits of using this regimen in individual patients.