摘要
目的系统评价预防性使用抗菌药物对关节镜术后感染的效果。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、CBM和WanFang Data数据库,搜集关于预防性使用抗菌药物预防关节镜术后感染的临床研究,检索时限均为1990年1月至2020年9月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果共纳入8个回顾性队列研究和1个随机对照试验,包括60136例患者。Meta分析结果显示:预防性使用抗菌药物组与未使用组感染率的差异无统计学意义[OR=0.51,95%CI(0.25,1.04),P=0.06]。亚组分析结果显示:对膝关节镜手术亚组而言,两组感染率的差异无统计学意义[OR=0.89,95%CI(0.65,1.23),P=0.48];而对肩关节镜手术亚组而言,预防性使用抗菌药物组感染率低于未使用组[OR=0.18,95%CI(0.08,0.37),P<0.00001]。结论当前证据显示,预防性使用抗菌药物不能降低膝关节镜手术术后感染风险,但有可能降低肩关节镜手术术后感染风险。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。
Objectives To systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.Methods PubMed,EMbase,The Cochrane Library,CNKI,CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies;then,meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.Results A total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60136 subjects were included.The results of the meta-analysis showed that:there was no difference in the postoperational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies(OR=0.51,95%CI0.25 to 1.04,P=0.06).For knee arthroscopies,the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis(OR=0.89,95%CI 0.65 to 1.23,P=0.48).However,for shoulder arthroscopies,the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18,95%CI 0.08 to 0.37,P<0.00001).Conclusions Current evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies.Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies.Due to the limited quality and quantity of the included studies,more high-quality studies are required to verify above conclusions.
作者
王佩华
卢菲
宗志勇
WANG Peihua;LU Fei;ZONG Zhiyong(Center of Infectious Diseases,West China Hospital of Sichuan University,Chengdu 610041,P.R.China;Department of Infection Control,West Hospital of Sichuan University,Chengdu 610041,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2020年第12期1397-1402,共6页
Chinese Journal of Evidence-based Medicine
基金
国家自然科学基金项目(编号:81861138055)
华西医院1·3·5基金项目(编号:ZYYC08006)。
