Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Nov-Dec;26(6):102705.
doi: 10.1016/j.bjid.2022.102705. Epub 2022 Oct 11.

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

Juliana Arruda de Matos  1 , Amanda da Silva Gomes  2 , Carla Ormundo G Ximenes Lima  2 , Carolina Arana Stanis Schmaltz  3 , Cristiane Rocha de Oliveira  2 , Grasiela Martins da Silva  2 , Júlia Herkenhoff Carijó  2 , Marilena Aguiar Lopes  2 , Quenia Cristina Dias Morais  2 , Pedro Emmanuel Alvarenga Americano do Brasil  4
Affiliations
Meta-Analysis

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

Juliana Arruda de Matos et al. Braz J Infect Dis. 2022 Nov-Dec.

Abstract

Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI.

Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software.

Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate).

Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

Keywords: Drug resistance, multiple; Gram-negative bacterial infections; Infection control; Surgical wound infection; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest JHC received consulting fees from MSD and support for attending meetings from MSD and Biomerieux.

Figures

Fig 1
Fig. 1
Inclusion and exclusion flowchart diagram.
Fig 2
Fig. 2
Meta-analysis comparing surgical antibiotic prophylaxis (SAP) with minoglycoside ("experimental") versus standard SAP without aminoglycoside ("control"). (A) outcome surgical site infection (SSI). (B) outcome multidrug resistant Gram negative bacilli SSI.
Fig 3
Fig. 3
Result of the risk of bias analysis in assessing the quality of cohort studies using ROBINS-I.
See this image and copyright information in PMC

References

    1. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96:1–15. - PubMed
    1. Blumberg TJ, Woelber E, Bellabarba C, Bransford R, Spina N. Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection. Spine J. 2018;18:300–306. - PubMed
    1. De Pastena M, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C, et al. Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center. Surgery. 2017;162:792–801. - PubMed
    1. Pereira MR, Scully BF, Pouch SM, Uhlemann A-C, Goudie S, Emond JE, et al. Risk factors and outcomes of carbapenem-resistant K lebsiella pneumoniae infections in liver transplant recipients: Klebsiella Pneumoniae Infections in LT Recipients. Liver Transpl. 2015;21:1511–1519. - PMC - PubMed
    1. Stewardson AJ, Allignol A, Beyersmann J, Graves N, Schumacher M, Meyer R, et al. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Euro Surveill. 2016;21:30319. - PMC - PubMed

MeSH terms