Prophylactic antibiotics to prevent SSI after breast canc

楚楚

Cochrane Database Syst Rev. 2012 Jan 18;1:CD005360.

Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

Bunn F, Jones DJ, Bell-Syer S.

Source

Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK, AL10 9AB.

AbstractBACKGROUND:

Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery.

OBJECTIVES:

To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery.

SEARCH METHODS:

For this second update we searched the Cochrane Wounds Group Specialised Register (searched 31 August 2011); theCochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (2008 to August Week 3 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 30 August 2011); Ovid EMBASE (1980 to 2011 Week 34); and EBSCO CINAHL (2008 to 25 August 2011). We applied no language or date restrictions.

SELECTION CRITERIA:

Randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer were included. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions.

DATA COLLECTION AND ANALYSIS:

Two review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria.

MAIN RESULTS:

A total of nine studies (2260 participants) is included in the review. Eight studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively significantly reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.71, 95% confidence interval (CI) 0.53 to 0.94). Analysis of the single study comparing perioperative antibiotic with no antibiotic found no statistically significant effect of antibiotics on the incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour.

AUTHORS' CONCLUSIONS:

Prophylactic antibiotics administered preoperatively reduce the risk of SSI in patients undergoing surgery for breast cancer. Further studies involving patients undergoing immediate breast reconstruction are needed as studies have identified this group as being at higher risk of infection than those who do not undergo immediate breast reconstruction.

星梦78

背景
使用预防性抗生素以预防乳癌手术后开刀部位发生感染
从过去几世纪以来，手术一直是治疗乳癌的方式之一，然而，任何手术都有发生感染的潜在风险。根据纪录显示，乳癌手术治疗后的感染率介于3 – 15% 之间，高于伤口保持清洁的手术感染率平均值。研究发现在其他类型手术的术前和术中投以抗生素可以有效降低感染率，然而对于是否将预防性抗生素用于乳癌手术则迄今尚未达成共识。
目标
探讨预防性抗生素对减少乳癌手术部位于术后发生感染的功效。
搜寻策略
我们搜寻了the Cochrane Wounds and Breast Cancer Groups Specialised Registers, the Cochrane Central Register of Controlled Trials (CENTRAL) (2006年第1期), MEDLINE (​​2002年到2005年), EMBASE (1980年到2005年), RR (2005年第1期), CINAHL (1982年到2004年) 以及SIGLE (1976年到2004年) 。我们联络了这个领域的专家及公司，同时还检阅了相关的文献清单，在语言上则并未采任何的限制。
选择标准
主题为探讨乳癌手术术前和术中给予抗生素、且主要结果指标为***伤口感染发生率以及手术不良反应之随机对照试验(Randomised controlled trials；RCTs)。
资料收集与分析
针对所有按搜寻策略找到的研究，由2位作者分别检视其标题与摘要，接着评估符合纳入标准的研究之品质，并从中摘录资讯。
主要结论
共6项研究符合选择标准。这6项研究都评估了术前抗生素和没有使用抗生素或使用安慰剂间的比较。统整这些研究的结果后发现，预防性抗生素明显可以降低未进行***重建手术之乳癌患者开刀部位的感染发生率(pooled RR 0.66, 95% CI, 0.48 to 0.89) 。没有研究个别呈现出移除***肿瘤的同时也进行重建手术的患者之数据。
作者结论
预防性抗生素可以降低乳癌病人的开刀部会发生感染的风险，一旦发生感染，将可能延迟伤口的愈合，或耽误到乳癌治疗而造成治疗成本上升，此外也可能会产生诸如药物反应或增加细菌抗药性等不良反应。比起肿瘤摘除后并未马上进行***重建手术的患者，手术后随即进行***重建被视为具高度感染的风险，因此接下来应有研究更进一步探讨这项议题。
翻译人
本摘要由成功大学附设医院邱晓萱翻译。
此翻译计画由台湾国家卫生研究院(National Health Research Institutes, Taiwan) 统筹。
总结
在手术之前服用抗生素是否可以减少开刀伤口发生感染的机会呢? 乳癌患者的人数约占所有新罹癌患者的十分之一，而透过外科手术将***移除是一常见的治疗方式。伤口发生感染是开刀常见的副作用，如果使用抗生素则可以显著减少发生感染的机会。本份文献回顾无法举出何种抗生素最适合使用。我们发现没有试验曾探讨过手术后随即进行***重建的议题。