预防性应用抗菌药物预防乳腺癌术后手术部位感染的荟萃分析
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摘要
目的:探讨预防性应用抗菌药物对乳腺癌术后手术部位感染的预防作用。方法:以"preoperative antibiotics/peri-operative antibiotics/prophylactic antibiotics"、"surgical site infection/wound infection/postoperative complications"、"mastectomy/wide local excision/breast reconstruction/axillary dissection"为关键词,查找1966年至2016年Pub Med、Cochrane Library、Embase、Science Direct、Wiley Inter Science、Scopus和Ovid数据库的RCT,无语言限制。2位评价者评价每一项研究的质量并提取数据。结果:12项RCT共计4 267例患者被纳入该荟萃分析。分析发现,预防性使用抗菌药物组可以显著降低手术部位感染(OR=0. 63,95%CI:0. 49～0. 81,P=0. 000 2)。按不同给药方式做亚组分析后,发现采用静脉抗生素的亚组,SSI的累积发生率(5. 5%)显著低于对照组(8. 2%)(OR=0. 65,95%CI:0. 50～0. 83,P=0. 000 7);按不同用药方案做亚组分析后,发现使用头孢地尼预防抗感染组发生SSI的累积发生率显著低于对照组(OR=0. 54,95%CI:0. 30～0. 94,P=0. 03)。结论:预防性使用抗菌药物可预防乳腺术后SSI的发生,进一步亚组分析提示采用静脉抗菌药物预防效果更佳,但由于亚组研究数量有限,仍需要更多高质量的RCT提供依据以建立最有效的预防方案和标准流程。
Objective: To assess the preventive effect of prophylactic( pre-or perioperative) antibiotics on the incidence of surgical site infection( SSI) after breast cancer surgery. Methods: We searched Pub Med,Cochrane Library,Embase,Science Direct,Wiley Inter Science,Scopus and Ovid with medical subject headings including 'preoperative antibiotics/peri-operative antibiotics/prophylactic antibiotics',' surgical site infection/wound infection/postoperative complications',' mastectomy/wide local excision/breast reconstruction/axillary dissection' from 1966 to 2016 for RCTs. Results: 12 trials with a total of 4 267 patients were identified,with the overall effect of antibiotics showing benefit for preventing SSI( OR = 0. 63,95% CI: 0. 49 ～ 0. 81,P = 0. 000 2). The cumulative incidence of SSI in patients used intravenous antibiotics was 5. 5%,which was lower than that in patients not used( 8. 2%)( OR = 0. 65,95% CI: 0. 50 ～0. 83,P = 0. 000 7). The cumulative incidence of SSI in cefonicid group was lower than non-antibiotics group( OR= 0. 54,95% CI: 0. 30 ～ 0. 94,P = 0. 03). Conclusion: The overall effect of prophylactic antibiotics treatment seems to be helpful for prevention of SSI. Subgroup analysis shows antibiotics benefits only by intravenous injection. The limited studies on subgroup analysis mean that only a limited conclusion on the use of antibiotic for prevention of SSI is possible.
Objective: To assess the preventive effect of prophylactic( pre-or perioperative) antibiotics on the incidence of surgical site infection( SSI) after breast cancer surgery. Methods: We searched Pub Med,Cochrane Library,Embase,Science Direct,Wiley Inter Science,Scopus and Ovid with medical subject headings including 'preoperative antibiotics/peri-operative antibiotics/prophylactic antibiotics',' surgical site infection/wound infection/postoperative complications',' mastectomy/wide local excision/breast reconstruction/axillary dissection' from 1966 to 2016 for RCTs. Results: 12 trials with a total of 4 267 patients were identified,with the overall effect of antibiotics showing benefit for preventing SSI( OR = 0. 63,95% CI: 0. 49 ～ 0. 81,P = 0. 000 2). The cumulative incidence of SSI in patients used intravenous antibiotics was 5. 5%,which was lower than that in patients not used( 8. 2%)( OR = 0. 65,95% CI: 0. 50 ～0. 83,P = 0. 000 7). The cumulative incidence of SSI in cefonicid group was lower than non-antibiotics group( OR= 0. 54,95% CI: 0. 30 ～ 0. 94,P = 0. 03). Conclusion: The overall effect of prophylactic antibiotics treatment seems to be helpful for prevention of SSI. Subgroup analysis shows antibiotics benefits only by intravenous injection. The limited studies on subgroup analysis mean that only a limited conclusion on the use of antibiotic for prevention of SSI is possible.
引文
[1] Witt A,Yavuz D,Walchetseder C,et al. Preoperative core needle biopsy as an independent risk factor for wound infection after breast surgery[J]. Obstet Gynecol,2003,101:745-750.
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[5] Blanchard D. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery[J]. Clin J Oncol Nurs,2015,19(5):629-630.
[6] Platt R,Zaleznik DF,Hopkins CC,et al. Perioperative antibiotic prophylaxis for hernioplasty and breast surgery[J]. New England Journal of Medicine,1990,322(3):153-160.
[7] Wagman LD,Tegtmeier B,Beatty JD,et al. A prospective,randomized double-blind study of the use of antibiotics at the time of mastectomy[J]. Surgery Gynecology and Obstetrics,1990,170(1):12-16.
[8] Amland PF,Andenaes K,Samdal F,et al. A prospective doubleblind,placebo-controlled trial of a single dose of azithromycin on postoperative wound infections in plastic surgery[J]. Plastic and Reconstructive Surgery,1995,96(6):1378-1383.
[9] Bold RJ,Mansfield PF,Berger DH,et al. Prospective randomised,double-blind study of prophylactic antibiotics in axillary lymph node dissection[J]. American Journal of Surgery,1998,176(3):239-243.
[10] Cabaluna ND,Galicia RM,Yray MDS. A randomized,doubleblinded placebo-controlled clinical trial of the routine use of preoperative antibiotic prophylaxis in modified radical mastectomy[J]. World Journal of Surgery,2012,37:59-66.
[11] Chow LW,Yuen KY,Woo PC,et al. Clarithromycin attenuates mastectomy-induced acute inflammatory response[J]. Clinical and Diagnostic Laboratory Immunology,2000,7(6):925-931.
[12] Gulluoglu B,Guler S,Ugurlu U. Efficacy of prophylactic antibiotic administration for breast cancer surgery in overweight or obese patients[J]. Annals of Surgery,2013,257(1):37-43.
[13] Gupta R,Sinnett D,Carpenter R,et al. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery[J]. European Journal of Surgical Oncology,2000,26(4):363-366.
[14] Hall JC,Willsher PC,Hall JL. Randomized clinical trial of single-dose antibiotic prophylaxis for non-reconstructive breast surgery[J]. British Journal of Surgery,2006,93(11):1342-1346.
[15] Paajanen H,Hermunen H. Does preoperative core needle biopsy increase surgical site infections in breast cancer surgery? Randomized study of antibiotic prophylaxis[J]. Surgical Infections,2009,10(4):317-321.
[16] Sanguinetti A,Rosato L,Cirocchi R,et al. Antibiotic prophylaxis in breast surgery. Preliminary results of a multicenter randomized study on 1 400 cases[J]. Annali Italiani di Chirurgia,2009,80(4):275-279.
[17] Yetim I,Ozkan OV,Dervisoglu A,et al.Effect of local gentamycin application on healing and wound infection in patients with modified radical mastectomy:A prospective randomised study[J]. Journal of International Medical Research,2010,38(4):1442-1447.
[18] Struik GM,Vrijland WW,Birnie E,et al. A randomized controlled trial on the effect of a silver carboxymethylcellulose dressing on surgical site infections after breast cancer surgery[J]. PLo S One,2018,13(5):e0195715.
[19] Chattha AS,Cohen JB,Bucknor A,et al. Surgical site infection in immediate breast reconstruction:Does chemotherapy timing make a difference[J]? J Surg Oncol,2018,117(7):1440-1446.
[2] Radovanovic Z,Radovanovic D,Golubovic A,et al. Early complications after nipple-sparing mastectomy and immediate breast reconstruction with silicone prosthesis:Results of 214 procedures[J].Scand J Surg,2010,99:115-118.
[3] Warren Peled A,Itakura K,Foster RD,et al. Impact of chemotherapy on postoperative complications after mastectomy and immediate breast reconstruction[J]. Arch Surg,2010,145:880-885.
[4] Li FC,Jiang HC,Li J. Immediate breast reconstruction with implants after skin-sparing mastectomy:A report of 96 cases[J].Aesthetic Plast Surg,2010,34:705-710.
[5] Blanchard D. Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery[J]. Clin J Oncol Nurs,2015,19(5):629-630.
[6] Platt R,Zaleznik DF,Hopkins CC,et al. Perioperative antibiotic prophylaxis for hernioplasty and breast surgery[J]. New England Journal of Medicine,1990,322(3):153-160.
[7] Wagman LD,Tegtmeier B,Beatty JD,et al. A prospective,randomized double-blind study of the use of antibiotics at the time of mastectomy[J]. Surgery Gynecology and Obstetrics,1990,170(1):12-16.
[8] Amland PF,Andenaes K,Samdal F,et al. A prospective doubleblind,placebo-controlled trial of a single dose of azithromycin on postoperative wound infections in plastic surgery[J]. Plastic and Reconstructive Surgery,1995,96(6):1378-1383.
[9] Bold RJ,Mansfield PF,Berger DH,et al. Prospective randomised,double-blind study of prophylactic antibiotics in axillary lymph node dissection[J]. American Journal of Surgery,1998,176(3):239-243.
[10] Cabaluna ND,Galicia RM,Yray MDS. A randomized,doubleblinded placebo-controlled clinical trial of the routine use of preoperative antibiotic prophylaxis in modified radical mastectomy[J]. World Journal of Surgery,2012,37:59-66.
[11] Chow LW,Yuen KY,Woo PC,et al. Clarithromycin attenuates mastectomy-induced acute inflammatory response[J]. Clinical and Diagnostic Laboratory Immunology,2000,7(6):925-931.
[12] Gulluoglu B,Guler S,Ugurlu U. Efficacy of prophylactic antibiotic administration for breast cancer surgery in overweight or obese patients[J]. Annals of Surgery,2013,257(1):37-43.
[13] Gupta R,Sinnett D,Carpenter R,et al. Antibiotic prophylaxis for post-operative wound infection in clean elective breast surgery[J]. European Journal of Surgical Oncology,2000,26(4):363-366.
[14] Hall JC,Willsher PC,Hall JL. Randomized clinical trial of single-dose antibiotic prophylaxis for non-reconstructive breast surgery[J]. British Journal of Surgery,2006,93(11):1342-1346.
[15] Paajanen H,Hermunen H. Does preoperative core needle biopsy increase surgical site infections in breast cancer surgery? Randomized study of antibiotic prophylaxis[J]. Surgical Infections,2009,10(4):317-321.
[16] Sanguinetti A,Rosato L,Cirocchi R,et al. Antibiotic prophylaxis in breast surgery. Preliminary results of a multicenter randomized study on 1 400 cases[J]. Annali Italiani di Chirurgia,2009,80(4):275-279.
[17] Yetim I,Ozkan OV,Dervisoglu A,et al.Effect of local gentamycin application on healing and wound infection in patients with modified radical mastectomy:A prospective randomised study[J]. Journal of International Medical Research,2010,38(4):1442-1447.
[18] Struik GM,Vrijland WW,Birnie E,et al. A randomized controlled trial on the effect of a silver carboxymethylcellulose dressing on surgical site infections after breast cancer surgery[J]. PLo S One,2018,13(5):e0195715.
[19] Chattha AS,Cohen JB,Bucknor A,et al. Surgical site infection in immediate breast reconstruction:Does chemotherapy timing make a difference[J]? J Surg Oncol,2018,117(7):1440-1446.