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Meta-Analysis
. 2020 Aug 4;8(8):CD013209.
doi: 10.1002/14651858.CD013209.pub2.

Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients

Samuel Chan  1 , Samantha Ng  1 , Hooi P Chan  2 , Elaine M Pascoe  3 , Elliott Geoffrey Playford  4 , Germaine Wong  5 , Jeremy R Chapman  6 , Wai H Lim  7 , Ross S Francis  1 , Nicole M Isbel  1 , Scott B Campbell  1 , Carmel M Hawley  1 , David W Johnson  1
Affiliations
Meta-Analysis

Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients

Samuel Chan et al. Cochrane Database Syst Rev. .

Abstract

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: To assess the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients.

Search 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: 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: 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: 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; I2 = 25%). The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). It is uncertain whether extended duration antibiotics reduces the incidence of surgical site infections in either solid organ transplant recipients (RR 1.19, 95% CI 0.58 to 2.48; 2 studies, 302 participants; I2 = 0%) or kidney-only transplant recipients (RR 0.50, 95% CI 0.05 to 5.48; 1 study, 205 participants) as the certainty of the evidence has been assessed as very low. The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). None of the eight included studies evaluated antimicrobial agent adverse reactions, graft health, cardiovascular disease, cancer, life participation, biochemical and haematological parameters, intervention cost, hospitalisation length, or overall hospitalisation costs.

Authors' 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.

Trial registration: ClinicalTrials.gov NCT02717273.

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Conflict of interest statement

  1. Samuel Chan: none known

  2. Samantha Ng: none known

  3. Hooi P Chan: none known

  4. E Geoffrey Playford: none known

  5. Germaine Wong: none known

  6. Jeremy R Chapman: none known

  7. Wai H Lim: has received funding from Astellas, Novartis and Alexion for advisory board memberships; speakers' fees from Astellas and Alexion and an education grant from Novartis

  8. Elaine M Pascoe: none known

  9. Nicole M Isbel: has received funding for participation in advisory boards and provision of educational lectures from Alexion Pharmaceuticals and Amgen on topics that are unrelated to this review

  10. Ross S Francis: has received support with travel expenses to attend conferences from Novartis and Amgen

  11. Scott B Campbell: none known

  12. Carmel M Hawley: has received fees from GlaxoSmithKline, Amgen, Shire, Roche, Abbott, Bayer, Fresenius, Baxter, Gambro, Janssen and Genzyme in relation to consultancy, speakers' fees, education, and grants for activities unrelated to this review

  13. David W Johnson: has previously received consultancy fees, research grants, speaker's honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care. He has also received consultancy fees from AstraZeneca and travel sponsorships from Amgen

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 1: Surgical site infections
1.2
1.2. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 2: Death (any cause)
1.3
1.3. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 3: Graft loss (including death with functioning graft)
1.4
1.4. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 4: Urinary tract infection
1.5
1.5. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 5: Septicaemia
1.6
1.6. Analysis
Comparison 1: Antibiotics versus no antibiotics, Outcome 6: Pneumonia
2.1
2.1. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 1: Surgical site infections
2.2
2.2. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 2: Death (any cause)
2.3
2.3. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 3: Graft loss (including death with functioning graft)
2.4
2.4. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 4: Urinary tract infection
2.5
2.5. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 5: Septicaemia
2.6
2.6. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 6: Pneumonia
2.7
2.7. Analysis
Comparison 2: Extended duration versus short duration antibiotics, Outcome 7: Wound exploration
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Chan 2018
    1. Chan S, Ng S, Chan HP, Pascoe E, Playford EG, Wong G, et al. Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients. Cochrane Database of Systematic Reviews 2018, Issue 12. Art. No: CD013209. [DOI: 10.1002/14651858.CD013209] - DOI - PMC - PubMed

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