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Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials

Published online by Cambridge University Press:  12 November 2018

Sumanth Gandra ,
Anna Trett ,
Gerardo Alvarez-Uria ,
Joseph S. Solomkin  and
Ramanan Laxminarayan Open the ORCID record for Ramanan Laxminarayan [Opens in a new window]
Sumanth Gandra
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom
Anna Trett
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom
Gerardo Alvarez-Uria
Affiliation:
Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, AP, India
Joseph S. Solomkin
Affiliation:
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
Ramanan Laxminarayan*
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC University of Strathclyde, Glasgow, Scotland, United Kingdom Princeton Environmental Institute, Princeton, New Jersey, United States
*
Author for correspondence: Ramanan Laxminarayan PhD, MPH, 1400 Eye St NW, Suite 500, Washington, DC 20005. E-mail: ramanan@cddep.org.
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Abstract

Objective

Rising antibiotic resistance could reduce the effectiveness of antibiotics in preventing postoperative infections. We investigated trends in the efficacy of antibiotic prophylaxis regimens for 3 commonly performed surgical procedures—appendectomy, cesarean section, and colorectal surgery—and 1 invasive diagnostic procedure, transrectal prostate biopsy (TRPB).

Design

Systematic review and meta-analysis.

Methods

We searched PubMed and Cochrane databases (through October 31, 2017) for randomized control trials (RCTs) that measured the efficacy of antibiotic prophylaxis for 4 index procedures in preventing postoperative infections (surgical site infections [SSIs] following the 3 surgical procedures and a combination of urinary tract infections [UTIs] and sepsis following TRPB).

Results

Of 399 RCTs, 74 studies (9 appendectomy, 11 cesarean section, 39 colorectal surgery, and 15 TRPB) were included. Multilevel logistic regression models with random intercepts for each study showed no statistically significant increase in SSIs over time for appendectomy (adjusted odds ratio [aOR] per year, 1.03; 95% confidence interval [CI], 0.92–1.16; P=.57), cesarean section (aOR per year, 1.01; 95% CI, 0.96–1.05; P=.80), and TRPB (aOR per year, 0.95; 95% CI, 0.77–1.18; P=.67). However, there was a significant increase in SSIs proportion following colorectal surgery (aOR per year, 1.049; 95% CI, 1.03–1.07; P<.001).

Conclusion

The efficacy of antibiotic prophylaxis agents in preventing SSIs following colorectal surgery has declined. Small number of RCTs and low infections rates limited our ability to assess true effect for simple appendectomy, cesarean section, or TRPB.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 2 , February 2019 , pp. 133 - 141
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

Cite this article: Gandra S, et al. (2019). Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials. Infection Control & Hospital Epidemiology 2019, 40, 133–141. doi: 10.1017/ice.2018.295

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