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Meta-Analysis
. 2024 Sep 1;110(9):5818-5832.
doi: 10.1097/JS9.0000000000001882.

Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis

Xiao-Fei Tang  1 , Xiang Bin  2 , Ke-Yi Qu  3 , Hong-Jun Liu  4 , Haike Lei  5 , Wei-Fan Li  1 , Zhou Min  6 , Yu Xia  6 , Li-Hua Dai  1 , Su-Ying Yu  7 , Yun-Ping Bao  3 , Jia-Quan Zhu  1 , Tan Bing  8
Affiliations
Meta-Analysis

Antibiotic prophylaxis for surgical wound infections in clean and clean-contaminated surgery: an updated systematic review and meta-analysis

Xiao-Fei Tang et al. Int J Surg. .

Abstract

Background: The efficacy and necessity of prophylactic antibiotics in clean and clean-contaminated surgery remains controversial.

Methods: The studies were screened and extracted using databases including PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials.gov according to predefined eligibility criteria. Randomized controlled trials (RCTs) comparing the effect of preoperative and postoperative prophylactic antibiotic use on the incidence of surgical site infections (SSIs) in patients undergoing any clean or clean-contaminated surgery.

Results: A total of 16 189 participants in 48 RCTs were included in the primary meta-analysis following the eligibility criteria. The pooled odds ratio (OR) for SSI with antibiotic prophylaxis versus placebo was 0.60 (95% CI: 0.53-0.68). The pooled OR among gastrointestinal, oncology, orthopedics, neurosurgery, oral, and urology surgery was 3.06 (95% CI: 1.05-8.91), 1.16 (95% CI: 0.89-1.50), 2.04 (95% CI: 1.09-3.81), 3.05 (95% CI: 1.25-7.47), 3.55 (95% CI: 1.78-7.06), and 2.26 (95% CI: 1.12-4.55), respectively. Furthermore, the summary mean difference (MD) for patients' length of hospitalization was -0.91 (95% CI: -1.61, -0.16). The results of sensitivity analyses for all combined effect sizes showed good stability.

Conclusion: Antibiotics are both effective, safe, and necessary in preventing surgical wound infections in clean and clean-contaminated procedures, attributed to their reduction in the incidence of surgical site infections as well as the length of patient hospitalization.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram of the systematic review and meta-analyses selection process.
Figure 2
Figure 2
A summary of the authors’ judgments of risk of bias for each included randomized controlled trial.
Figure 3
Figure 3
Funnel plot for evaluating overall publication bias. The horizontal line represents the summary effect estimates, and the dotted lines are pseudo-95% CIs. OR, odds ratio.
Figure 4
Figure 4
Meta-regression analysis of prophylactic antibiotics and surgical site infections. The horizontal line represents the summary effect estimates, and the diagonal lines represent pseudo-95% CI limits. SND, small-N designs.
Figure 5
Figure 5
Forest plot of overall effect comparing antibiotics with placebo. df, degrees of freedom; M-H, Mantel-Haenszel; OR, odds ratio.
Figure 6
Figure 6
Forest plot of subgroup analyses comparing antibiotic versus placebo effects. df, degrees of freedom; M-H, Mantel-Haenszel; OR, odds ratio.
Figure 7
Figure 7
Funnel plots for evaluating subgroup publication bias. OR, odds ratio.
Figure 8
Figure 8
Meta-regression analysis of prophylactic antibiotics and surgical site infections in subgroup analysis. G=gastrointestinal surgery, O=oncology surgery, R=orthopedic surgery, A=neurosurgery, N=oral surgery, T=urology, Z=Total value of subgroup analysis. SND, small-N designs.
Figure 9
Figure 9
Forest plot of the overall length-of-hospitalization effect of antibiotics versus placebo. df, degrees of freedom; MD, mean difference.
Figure 10
Figure 10
Forest plot of an overall adverse effect of antibiotics versus placebo. df, degrees of freedom; RD, risk difference.
See this image and copyright information in PMC

References

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