Abstract
The objective of the present study was to assess the available evidence regarding antibiotic prophylaxis taking the case of abdominal hysterectomy, as an aid to decisions related to coverage and to the development of evidence-based clinical guidelines. Using a previously elaborated protocol, the pertinence and quality of double-blind, randomized, placebo-controlled trials were examined. Clinical heterogeneity among studies was also analyzed. The studies were found to be homogeneous, considering p > 0.10 as the significance level for rejecting heterogeneity. Combination of the 16 selected studies resulted in a summary rate ratio of 0.49 (95%CI: 0.41-0.59), i.e., efficacy of 51%, and in a summary rate difference of 11% (95%CI: 8-14), utilizing the fixed effects model. Results according to the random effects model were very similar. Exploratory analysis of subgroups of single versus multiple doses did not indicate more benefit for multiple dose interventions. Evidence from comparative trials is insufficient to consider third-generation cephalosporins more efficacious than first-generation ones.
Highlights
A infecção pós-cirúrgica é um problema relevante de saúde
The objective of the present study was to assess the available evidence regarding antibiotic prophylaxis taking the case of abdominal hysterectomy, as an aid to decisions related to coverage and to the development of evidence-based clinical guidelines
A meta-análise é uma forma de revisão sistemática na qual é efetuada uma combinação quantitativa dos resultados de vários estudos, para a obtenção de uma estimativa única do resultado, ou seja, uma medida sumária do(s) efeito(s) analisado(s) 4,5
Summary
No intuito de subsidiar a análise da qualidade e da heterogeneidade clínica dos ensaios sobre a antibioticoprofilaxia, procedemos o exame da evidência sobre fatores prognósticos de infecção pós-cirúrgica, a seguir. De acordo com o protocolo da presente revisão, foram considerados os seguintes critérios para inclusão de ensaios clínicos: (a) ser um estudo randomizado e duplo-cego; (b) apresentar comparação entre grupo(s) submetido(s) à antibioticoprofilaxia e grupo controlado por placebo ou comparativo em pacientes submetidas à histerectomia abdominal eletiva, não radical; (c) ter iniciado a profilaxia pela via parenteral até 2 horas antes do início da cirurgia; (d) ter como desfecho geral a infecção do sítio operatório, incluindo os casos relativos aos subtipos de infecção da ferida operatória (superficial e profunda) e de infecção pélvica (intra cavitária), tomando-se por base as definições do Centers for Disease Control and Prevention (CDC) 30,31 (Tabela 1). Taxas de infecção do sítio cirúrgico em ensaios clínicos placebo-controlados de antibioticoprofilaxia na histerectomia abdominal eletiva, não radical
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