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J Antimicrob Chemother. 2012 Mar;67(3):541-50. Epub 2011 Nov 13.
Antibiotic prophylaxis in cardiac surgery: systematic review and meta-analysis.Lador A, Nasir H, Mansur N, Sharoni E, Biderman P, Leibovici L, Paul M.
SourceMedicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
AbstractBACKGROUND: Antibiotic prophylaxis is recommended in cardiac surgery. Current debate concerns the type of antibiotic(s), dosing and the duration of prophylaxis.目前在心脏外科预防性使用方面的争议是种类、剂量和疗程
METHODS: Systematic review of randomized controlled trials comparing one antibiotic regimen versus another in cardiac surgery. We searched The Cochrane Library, PubMed, LILACS, conference proceedings and bibliographies. Two reviewers independently extracted the data. The primary outcome was deep sternal wound infections (DSWIs). Meta-analysis was performed using the Mantel-Haenszel fixed-effect method. Risk ratios (RRs) with 95% confidence intervals (95% CIs) are reported.
RESULTS: Fifty-nine trials were included. There were no significant differences in DSWI or all other categories of surgical site infections (SSIs) for antibiotic prophylaxis with β-lactams comprising a Gram-negative spectrum of coverage versus prophylaxis targeting Gram-positive bacteria, but the former led to a significantly lower rate of post-operative pneumonia (RR 0.68, 95% CI 0.51-0.90) and all-cause mortality (RR 0.66, 95% CI 0.47-0.92).选用覆盖革兰阴性细菌与革兰阳性细菌的β内酰胺类抗菌药物，对深部胸骨伤口感染或所有其他种类的SSI没有明显差异，但前者所致术后肺炎明显较低。 In trials comparing different antibiotic regimens for different durations, prophylaxis duration of ≤24 h post-operation led to higher rates of DSWI (RR 1.83, 95% CI 1.25-2.66)，any sternal SSI, surgical interventions for SSI and endocarditis compared with longer duration prophylaxis. 相比于较长的预防性使用疗程，术后使用疗程≤24h深部胸骨伤口感染，任何胸骨SSI、SSI外科干预以及心内膜炎均明显较高, There was no advantage of regimens lasting >48 h post-operation.术后使用时间＞48h没有任何益处。 In the comparison of glycopeptides versus β-lactams, an advantage of glycopeptides was observed when comparators were given for similar duration and for β-lactams when given for a longer duration than the glycopeptides. β内酰胺类与氨基糖苷类比较，当使用相同的疗程时和β内酰胺类相比于氨基糖苷类使用疗程较长时，氨基糖苷类有优势。There was no significant advantage of high antibiotic dosing.大剂量使用抗菌药物没有明显优势。
CONCLUSIONS: Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively.证据支持选用二代和三代头孢菌素作为心脏外科预防性使用，使用时间延长至术后48h可能是有好处的。（翻译得可能不够准确，请高手批评指正）
Comment in
卫生部[2009]38号文件，常见手术推荐使用的抗菌药物种类：
心脏大血管手术：第一、二代头孢菌素 由此思考，卫生行政部门发文，是不是不要涉及具体的专业问题？一是短短的行政文件，不能将有些专业问题讲清楚，二是学术研究在不断发展和更新，而文件有时候更新不那么快？
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发表于 2012-6-8 08:26
发表于 2012-6-8 08:37