Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.

  • Review
  • Intervention

Authors


Abstract

Background

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. The cause of appendicitis is unclear and the mechanism of pathogenesis continues to be debated. Despite improved asepsis and surgical techniques, postoperative complications, such as wound infection and intraabdominal abscess, still account for a significant morbidity. Several studies implicate that postoperative infections are reduced by administration of antimicrobial regimes.

Objectives

This review evaluated the use of antibiotics compared to placebo or no treatment in patients undergoing appendectomy. Will these patients benefit from antimicrobial prophylaxis? The outcomes were described according to the nature of the appendix, as either simple appendicitis (including the non-infectious stage) and complicated appendicitis. The efficacy of different antibiotic regimens were not evaluated.

Search methods

We searched The Cochrane Central Register of Controlled Trials (Cochrane Library 2005 issue 1); Pubmed ; EMBASE; and the Cochrane Colorectal Cancer Group Specialised Register (April 2005). In addition, we manually searched the reference lists of the primary identified trials.

Selection criteria

We evaluated Randomised Controlled Trials (RCTs) and Controlled Clinical Trials (CCTs) in which any antibiotic regime were compared to placebo in patients suspected of having appendicitis, and undergoing appendectomy. Both studies on children and adults were reviewed. The outcome measures of the studies were: Wound infection, intra abdominal abscess, length of stay in hospital, and mortality.

Data collection and analysis

Eligibility and trial quality were assessed, recorded and cross-checked by two reviewers.

Main results

Forty-five studies including 9576 patients were included in this review. The overall result is that the use of antibiotics is superior to placebo for preventing wound infection and intraabdominal abscess, with no apparant difference in the nature of the removed appendix. Studies exclusively on children and studies examining topical application reported results in favour to the above, although the results were not significant.

Authors' conclusions

Antibiotic prophylaxis is effective in the prevention of postoperative complications in appendectomised patients, whether the administration is given pre-, peri- or post-operatively, and could be considered for routine in emergency appendectomies.

摘要

背景

抗生素與安慰劑在闌尾切除術後預防感染所扮演的角色

闌尾炎是最常見的腹部急症且需要緊急進行手術。致病原因目前仍不明確,致病機轉仍在討論中。儘管開刀技術已進步許多,但術後併發症,如:傷口感染、腹內膿瘍…等等併發症仍影響很大。部分研究指出在術後給予抗生素,能降低術後感染。

目標

此次的回顧是為了評估闌尾切除術後的病人給予抗生素與安慰劑,或不做任何治療的效果。給予預防性的抗生素是否有較好的預後?最後依據闌尾炎的致病原因(感染或非感染)來做結論。給予不同的抗生素的療效並不在本篇的討論範圍。

搜尋策略

我們搜尋了以下資料庫及臨床試驗: The Cochrane Central Register of Controlled Trials (Cochrane Library 2005 issue 1); Pubmed; EMBASE; and the Cochrane Colorectal Cancer Group Specialised Register (2005四月)。另外,我們再額外搜尋了這些臨床試驗引用之文章。

選擇標準

我們評估了隨機對照試驗(Randomised Controlled Trials, RCTs)及對照臨床試驗(Controlled Clinical Trials, CCTs)中,在疑似闌尾炎及進行闌尾切除術的病人身上給予任何抗生素與安慰劑的比較。這些研究都包括了成人與小孩。研究評估包括傷口感染、腹內膿瘍、住院天數及死亡率。

資料收集與分析

臨床試驗的合適性與品質經由兩位審閱者評估、紀錄以及交叉比對。

主要結論

這次分析包括了45個研究,總共9576個病人。總結全部的研究,不管是闌尾炎的致病原因為何,對於傷口感染與腹內膿瘍的預防,抗生素優於安慰劑。儘管研究結果不顯著,一些小孩研究及外用抗生素的研究結論也是跟之前一樣。

作者結論

使用預防性抗生素對於減少闌尾炎術後併發症,不論是在術前、術中還是術後都是有效的,甚至在緊急闌尾切除手術中,預防性抗生素是可以常規使用。

翻譯人

本摘要由臺北榮民總醫院吳嘉榮翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

預防性抗生素在緊急闌尾切除術可以常規使用。闌尾炎是最常見的腹部急症且需要進行緊急手術,這樣會增加術後的併發症,其中最常見的就是傷口感染。標準預防方式是給予抗生素治療。為了減少醫療費用、藥物毒性及產生細菌抗藥性,建立最短且有效的預防性治療是值得期待的。這次研究回顧了解不管在闌尾切除之術前、術中或術後使用預防性抗生素,對於預防術後併發症是有效的。

Plain language summary

Antibiotic prophylaxis could be considered for routine in emergency appendectomies.

Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. This is associated with increased risk of postoperative complications, wound infection being the most commonly reported. Standard prophylaxis is an anti-bacterial treatment. In order to reduce cost, toxicity and the risk of developing bacterial resistance, it is desirable to establish the shortest and most effective prophylaxis for postoperative complications.
This review reports that antibiotic prophylaxis is effective in the prevention of postoperative complications in people who had the appendix removed. Regardless whether the antibiotic was given before, during or after the surgery.