围手术期不同抗生素使用时长对预防脊柱手术部位感染有效性的网状Meta分析

Efficacy of different durations of perioperative antibiotics to prevent surgical site infection after spinal surgery:a network Meta-analysis

目的:对围手术期不同抗生素使用时长预防脊柱手术部位感染(surgical site infection,SSI)的有效性进行评价。方法:计算机检索PubMed、Embase、The Cochrane Library、中国知网、维普、万方数据库,搜集围手术期预防性抗生素的使用时长对降低脊柱SSI发生率的临床研究。研究类型包括随机对照试验(randomized controlled trial,RCT)和队列研究(cohort study,CS)。检索时限为2000年1月1日~2020年5月4日。由2名研究者严格遵循纳入与排除标准独立进行文献筛选、数据提取和文献质量评价。将抗生素使用时长分为单剂量组、术后24h组、术后48h组和术后超48h组。应用Stata 14软件进行网状Meta分析,比较不同抗生素使用时长对降低脊柱SSI发生率的有效性。结果:共纳入10篇文献,包括5篇RCT、2篇前瞻性队列研究和3篇回顾性队列研究,涉及4类抗生素使用时长(单剂量、术后24h、术后48h、术后超48h)。网状Meta分析结果显示:在降低脊柱SSI发生率方面,术后24h组[RR=0.48,95%CI(0.23,0.99)]和术后超48h组[RR=0.52,95%CI(0.32,0.84)]优于单剂量,其差异有统计学意义;排序结果显示术后24h组优于其他使用时长。结论:当前证据显示抗生素使用时长为术后24h时对预防脊柱SSI的效果最佳。

Objectives:To investigate the efficacy of different durations of perioperative antibiotics to prevent surgical site infection after spinal surgery.Methods:PubMed,Embase,The Cochrane Library,CNKI,VIP and WanFang databases were electronically searched to collect clinical studies about different durations of perioperative prophylactic antibiotics for reducing the SSI rate after spinal surgery.The design of studies included randomized controlled trials(RCTs)and cohort studies(CSs).Retrieval time was from January 1,2000 to May 4,2020.Two reviewers independently screened literature,extracted data and assessed the quality of included studies following the inclusion and exclusion criteria.The durations of antibiotics were divided into single-dose group,postoperative 24h group,postoperative 48h group and postoperative over 48h group.Network Meta-analysis was conducted in STATA 14 software to compare the efficacy of different durations of perioperative antibiotic for reducing the SSI rate after spinal surgery.Results:Ten studies were eligible for this analysis including 5 RCTs,2 prospective cohort studies and 3 retrospective cohort studies.Four durations of antibiotics were involved(single-dose,postoperative 24h,postoperative 48h,postoperative over 48h).For network Meta-analysis,postoperative 24h group[RR=0.48,95%CI(0.23,0.99)]and postoperative over 48h group[RR=0.52,95%CI(0.32,0.84)]were superior to single-dose group for reducing the SSI rate.The ranking results suggested that the efficacy of postoperative 24h group was better than other durations.Conclusions:The evidence shows that the efficacy of antibiotic duration of postoperative 24h is probably optimal.