背景:蜂窝织炎被定义为皮肤的感染,其特征通常是局部但分界不清的红斑区域,肿胀,和痛苦。丹毒是蜂窝织炎的一种亚型,其特征是更浅表的感染,经常涉及面部。因为革兰氏阳性菌是最常见的感染因子,β-内酰胺抗生素如头孢菌素是常用的。然而,指南和医生的偏好差异很大,因为存在不同的抗生素选择和给药途径,除了大多数病例在没有微生物实验室指导的情况下进行经验性治疗。这种证据缺乏标准化,指导方针,和医师实践促使我们对随机试验数据和队列研究进行系统评价和荟萃分析,以汇总目前可获得的关于蜂窝织炎治疗中抗生素最佳给药途径的证据.
目的:我们综述的主要目的是比较口服与静脉注射抗生素治疗蜂窝织炎感染的疗效,从而为临床医生提供循证治疗指南。
方法:我们将搜索MEDLINE,Embase,和CENTRAL通过Ovid以及WebofScience和CINAHL获得了所有可用文献,比较了不同的抗生素给药途径治疗蜂窝织炎和丹毒。我们将根据PRISMA(系统评价和荟萃分析的首选报告项目)指南进行标题和摘要以及全文一式两份的筛选,然后使用预先编制的数据表提取相关数据。我们审查的主要结果是感染消退的持续时间,和次要结果,如败血症的发生率,死亡率,入院,和艰难梭菌感染。我们将使用RoB2.0(修订后的随机试验中的偏倚风险工具)和ROBINS-I(非随机干预研究中的偏倚风险)工具评估纳入研究的偏倚风险。最终质量评估使用等级(建议分级,评估,发展,和评估)框架和敏感性分析,以检查异质性。
结果:我们将在同行评审的学术期刊上发布我们系统综述的最终结果。该项目没有获得资金或财政援助。目前正在进行数据分析,结果预计将于2023年11月下旬提交发布。
结论:据我们所知,这将是对蜂窝织炎不同抗生素给药途径的最佳现有证据的最新回顾.由于可用的抗生素选择和治疗的经验性,我们预计数据存在异质性,但仍希望提供关于静脉内与口服抗生素治疗蜂窝织炎疗效的综合证据.我们希望这项研究的结果将更好地指导未来的医生实践蜂窝织炎感染。
■PRR1-10.2196/48342。
BACKGROUND: Cellulitis is defined as an infection of the skin that is usually characterized by localized but poorly demarcated areas of erythema, swelling, and pain. Erysipelas is a subtype of cellulitis that is characterized by a more superficial infection, often involving the face. Because gram-positive bacteria are the most common infective agent, beta-lactam antibiotics such as cephalosporins are commonly used. However, guidelines and physician preference vary widely as different antibiotic options and routes of administration exist, in addition to the fact that most cases are treated empirically without microbiological lab guidance. This lack of standardization in evidence, guidelines, and physician practice prompted this systematic
review and meta-analysis of both randomized trial data and cohort studies to aggregate the currently available evidence for the optimal routes of antibiotic administration in cellulitis treatment.
OBJECTIVE: The primary objective of our review is to compare the efficacy of oral versus intravenous antibiotic administration for cellulitis infections, thereby providing clinicians with evidence-based guidelines for treatment.
METHODS: We will search MEDLINE, Embase, and CENTRAL through Ovid as well as Web of Science and CINAHL for all available literature comparing different routes of antibiotic administration in the treatment of cellulitis and erysipelas. We will perform title and abstract as well as full-text screening in duplicate according to the PRISMA (Preferred Reporting Items for Systematic
Review and Meta-Analyses) guidelines and then extract the relevant data using a prepiloted data sheet. The primary outcome for our
review is the duration of infection resolution, and secondary outcomes such as incidence of sepsis, mortality, hospital admission, and Clostridium difficile infection. We will assess the risk of bias in our included studies using the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk of bias in non-randomized studies for interventions) tools, with a final quality assessment using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework and a sensitivity analysis to examine heterogeneity.
RESULTS: We will publish the final results of our systematic
review in a peer-reviewed academic journal. This project received no funding or financial assistance. Data analysis is currently underway, and the results are expected to be submitted for publication in late November 2023.
CONCLUSIONS: To our knowledge, this will be the most up-to-date
review of the best available evidence comparing different routes of antibiotic administration for cellulitis. Because of the vast selection of antibiotic options available and the empirical nature of the treatment, we anticipate heterogeneity within our data but nonetheless hope to provide aggregated evidence on the efficacy of intravenous versus oral administration of antibiotics in cellulitis treatment. We hope the results from this study will better inform physician practices in the future for cellulitis infections.
UNASSIGNED: PRR1-10.2196/48342.