Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients.
Journal
The Cochrane database of systematic reviews
ISSN: 1469-493X
Titre abrégé: Cochrane Database Syst Rev
Pays: England
ID NLM: 100909747
Informations de publication
Date de publication:
04 Aug 2020
04 Aug 2020
Historique:
entrez:
18
8
2020
pubmed:
18
8
2020
medline:
21
10
2020
Statut:
epublish
Résumé
Solid organ transplant recipients are at high risk for infections due to the complexity of surgical procedures combined with the impact of immunosuppression. No consensus exists on the role of antibiotics for surgical site infections in solid organ transplant recipients. To assess the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients. The Cochrane Kidney and Transplant Register of Studies was searched up to 21 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. All randomised controlled trials (RCTs) and quasi-RCTs in any language assessing prophylactic antibiotics in preventing surgical site infections in solid organ transplant recipients at any time point after transplantation. Two authors independently determined study eligibility, assessed quality, and extracted data. Primary outcomes were surgical site infections and antimicrobial resistance. Other outcomes included urinary tract infections, pneumonias and septicaemia, death (any cause), graft loss, graft rejection, graft function, adverse reactions to antimicrobial agents, and outcomes identified by the Standardised Outcomes of Nephrology Group (SONG), specifically graft health, cardiovascular disease, cancer and life participation. Summary effect estimates were obtained using a random-effects model and results were expressed as risk ratios (RR) and 95% confidence intervals (CI). The quality of the evidence was assessed using the risk of bias and the GRADE approach. We identified eight eligible studies (718 randomised participants). Overall, five studies (248 randomised participants) compared antibiotics versus no antibiotics, and three studies (470 randomised participants) compared extended duration versus short duration antibiotics. Risk of bias was assessed as high for performance bias (eight studies), detection bias (eight studies) and attrition bias (two studies). It is uncertain whether antibiotics reduce the incidence of surgical site infections as the certainty of the evidence has been assessed as very low (RR 0.42, 95% CI 0.21 to 0.85; 5 studies, 226 participants; I Due to methodological limitations, risk of bias and significant heterogeneity, the current evidence for the use of prophylactic perioperative antibiotics in transplantation is of very low quality. Further high quality, adequately powered RCTs would help better inform clinical practice.
Sections du résumé
BACKGROUND
BACKGROUND
Solid organ transplant recipients are at high risk for infections due to the complexity of surgical procedures combined with the impact of immunosuppression. No consensus exists on the role of antibiotics for surgical site infections in solid organ transplant recipients.
OBJECTIVES
OBJECTIVE
To assess the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients.
SEARCH METHODS
METHODS
The Cochrane Kidney and Transplant Register of Studies was searched up to 21 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov.
SELECTION CRITERIA
METHODS
All randomised controlled trials (RCTs) and quasi-RCTs in any language assessing prophylactic antibiotics in preventing surgical site infections in solid organ transplant recipients at any time point after transplantation.
DATA COLLECTION AND ANALYSIS
METHODS
Two authors independently determined study eligibility, assessed quality, and extracted data. Primary outcomes were surgical site infections and antimicrobial resistance. Other outcomes included urinary tract infections, pneumonias and septicaemia, death (any cause), graft loss, graft rejection, graft function, adverse reactions to antimicrobial agents, and outcomes identified by the Standardised Outcomes of Nephrology Group (SONG), specifically graft health, cardiovascular disease, cancer and life participation. Summary effect estimates were obtained using a random-effects model and results were expressed as risk ratios (RR) and 95% confidence intervals (CI). The quality of the evidence was assessed using the risk of bias and the GRADE approach.
MAIN RESULTS
RESULTS
We identified eight eligible studies (718 randomised participants). Overall, five studies (248 randomised participants) compared antibiotics versus no antibiotics, and three studies (470 randomised participants) compared extended duration versus short duration antibiotics. Risk of bias was assessed as high for performance bias (eight studies), detection bias (eight studies) and attrition bias (two studies). It is uncertain whether antibiotics reduce the incidence of surgical site infections as the certainty of the evidence has been assessed as very low (RR 0.42, 95% CI 0.21 to 0.85; 5 studies, 226 participants; I
AUTHORS' CONCLUSIONS
CONCLUSIONS
Due to methodological limitations, risk of bias and significant heterogeneity, the current evidence for the use of prophylactic perioperative antibiotics in transplantation is of very low quality. Further high quality, adequately powered RCTs would help better inform clinical practice.
Identifiants
pubmed: 32799356
doi: 10.1002/14651858.CD013209.pub2
pmc: PMC7437398
doi:
Substances chimiques
Anti-Bacterial Agents
0
Banques de données
ClinicalTrials.gov
['NCT02717273']
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
CD013209Informations de copyright
Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Références
Arch Surg. 1994 Dec;129(12):1310-6; discussion 1316-7
pubmed: 7986162
Antimicrob Agents Chemother. 1991 Jan;35(1):208-10
pubmed: 2014978
Z Urol Nephrol. 1986 Oct;79(10):545-8
pubmed: 3544597
Am J Transplant. 2008 Aug;8(8):1737-43
pubmed: 18557723
Transpl Infect Dis. 2015 Dec;17(6):800-9
pubmed: 26341757
Transplantation. 2005 Dec 27;80(12):1742-8
pubmed: 16378070
Ann Intern Med. 2002 Jun 4;136(11):834-44
pubmed: 12044132
Surg Infect (Larchmt). 2013 Feb;14(1):73-156
pubmed: 23461695
Enferm Infecc Microbiol Clin. 1990 Feb;8(2):74-7
pubmed: 2098143
Clin Infect Dis. 2001 Jul 1;33 Suppl 1:S26-31
pubmed: 11389519
Br Med Bull. 2013;106:117-34
pubmed: 23645842
Am J Surg. 2013 Jul;206(1):8-15
pubmed: 23706259
Infect Control Hosp Epidemiol. 1999 Nov;20(11):725-30
pubmed: 10580621
J Heart Lung Transplant. 2007 Mar;26(3):241-9
pubmed: 17346626
Transplantation. 2001 Dec 27;72(12):1920-3
pubmed: 11773889
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Scand J Urol Nephrol. 1984;18(3):215-21
pubmed: 6387898
Nephrol Dial Transplant. 1998 Jul;13(7):1637-41
pubmed: 9681704
Cochrane Database Syst Rev. 2020 Aug 4;8:CD013209
pubmed: 32799356
J Hosp Infect. 1988 May;11(4):357-63
pubmed: 2899588
Infect Control. 1980 Mar-Apr;1(2):93-6
pubmed: 7033157
Antimicrob Agents Chemother. 1978 Feb;13(2):214-20
pubmed: 348094
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
Hepatogastroenterology. 2006 Mar-Apr;53(68):234-42
pubmed: 16608031
Transplantation. 2009 May 15;87(9):1387-93
pubmed: 19424041
Eur J Cardiothorac Surg. 2003 Oct;24(4):601-7
pubmed: 14500081
J Antimicrob Chemother. 1988 Sep;22(3):363-9
pubmed: 3053562
Infect Control Hosp Epidemiol. 2008 Dec;29(12):1099-106
pubmed: 18973455
J Hosp Infect. 2008 Nov;70 Suppl 2:3-10
pubmed: 19022115
Liver Transpl. 2019 Jul;25(7):1043-1053
pubmed: 31063679
Am J Surg. 1995 May;169(5):480-3
pubmed: 7747823
Am J Transplant. 2017 Apr;17(4):856-879
pubmed: 28117944
Semin Dial. 2005 Nov-Dec;18(6):505-10
pubmed: 16398714
Transplant Proc. 2013 May;45(4):1392-5
pubmed: 23726580
Nephrol Dial Transplant. 2018 May 1;33(5):881-889
pubmed: 29342279
Arch Surg. 1995 Sep;130(9):989-93
pubmed: 7661686
Transplant Proc. 2007 Sep;39(7):2222-4
pubmed: 17889144
Transpl Int. 1990 May;3(1):12-4
pubmed: 2369474
Transplantation. 2018 Aug;102(8):1358-1366
pubmed: 29470347
Transplantation. 2018 Jan;102(1):21-34
pubmed: 28614192
Surgery. 2001 Aug;130(2):388-95
pubmed: 11490376
Surgery. 2015 Jan;157(1):104-10
pubmed: 25304836
J Clin Epidemiol. 2011 Apr;64(4):383-94
pubmed: 21195583