AVOIDING SERIOUS INFECTIONS ASSOCIATED WITH ABDOMINAL HYSTERECTOMY - A METAANALYSIS OF ANTIBIOTIC-PROPHYLAXIS

被引:105
作者
MITTENDORF, R
ARONSON, MP
BERRY, RE
WILLIAMS, MA
KUPELNICK, B
KLICKSTEIN, A
HERBST, AL
CHALMERS, TC
机构
[1] TUFTS UNIV,SCH MED,DEPT OBSTET & GYNECOL,BOSTON,MA 02111
[2] TUFTS UNIV NEW ENGLAND MED CTR,BOSTON,MA
[3] UNIV WASHINGTON,SCH PUBL HLTH,DEPT EPIDEMIOL,SEATTLE,WA 98195
[4] HARVARD UNIV,SCH PUBL HLTH,TECHNOL ASSESSMENT GRP,BOSTON,MA 02115
关键词
METAANALYSIS; ANTIBIOTIC PROPHYLAXIS; TOTAL ABDOMINAL HYSTERECTOMY; CEFAZOLIN; METRONIDAZOLE; TINIDAZOLE;
D O I
10.1016/0002-9378(93)90266-L
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: Our objective was to determine whether the use of preoperative antibiotics prevents serious infections associated with total abdominal hysterectomy. STUDY DESIGN: We identified 25 randomized controlled trials of antibiotic prophylaxis that used rigorous protocols. We performed meta-analyses and cumulative meta-analyses for all of the trials, and then we performed separate meta-analyses for cefazolin, metronidazole, and tinidazole. RESULTS: Overall, 21.1% (373 of 1768) of the patients who did not receive antibiotic prophylaxis had serious infections after abdominal hysterectomy. Among patients who received any antibiotics, we found that 9.0% (166/1836) had serious postoperative infections; among those who received cefazolin, metronidazole, or tinidazole, 11.4% (70 of 615), 6.3% (17 of 269), and 5.0% (5 of 101), respectively, had serious postoperative morbidity. The differences in the prevalence of infection between women who received prophylaxis and women who did not receive prophylaxis were statistically significant (any antibiotics, p = 0.00001; cefazolin, p = 0.00021; metronidazole, p = 0.015; and tinidazole, p = 0.034). CONCLUSION: Because preoperative antibiotics are highly effective in the prevention of serious infections associated with total abdominal hysterectomy, we believe they should be used routinely. In addition, we believe that the use of controls who receive no treatment is no longer justified in trials of antibiotic prophylaxis for total abdominal hysterectomy.
引用
收藏
页码:1119 / 1124
页数:6
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