Antibiotic prophylaxis versus no prophylaxis

楚楚

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007482.
Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.Smaill FM, Gyte GM.
SourceDepartment of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Room 2N16, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.

AbstractBACKGROUND: The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.
OBJECTIVES: To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).
SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
MAIN RESULTS: We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.
AUTHORS' CONCLUSIONS: Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.

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摘要
背景
预防性抗生素使用与否对于剖腹产术后感染之预防效果

产后母亲感染的唯一最重要的危险因子是剖腹产。常规的预防性抗生素使用可能可以减少这种风险，其好处及坏处应当加以评估。

目标
为了评估预防性抗生素的使用对于接受剖腹产的妇女发生感染的预防效果。

搜寻策略
我们搜寻了2009年5月的Cochrane Pregnancy and Childbirth Group's Trials Regster。

选择标准
比较预防性抗生素使用与否对于接受剖腹产的妇女发生感染的预防效果之随机对照试验(randomized controlled trials, RCTs)和准随机对照试验(quasi?RCTs) 。

资料收集与分析
两位作者独立地评估研究是否纳入及研究偏差的风险，并进行数据摘提。

主要结论
我们收集了包含1万3千名妇女的86个研究。预防性应用抗生素的妇女接受剖腹产的发病率大大降低了产后发烧的发生率(平均风险比(RR)0.45; 95％可信区间(CI)0.39至0.51，50个研究，8141名妇女)，伤口感染率(平均风险比: 0.39; 95％信赖区间0.32至0.48，77个研究，11961名妇女)，子宫内膜炎发生率(RR 0.38，95％CI 为0.34至0.42，79个研究，12142名妇女)和产妇发生严重感染并发症的机会(RR 0.31，95％CI 为0.19至0.48，31个研究，5047妇女)。这些研究中，抗生素对产妇的其他不良影响没有结论RR 2.43，95％CI 为1.00～5.90，13项研究，2131名妇女。在86个研究中也没有报告婴儿有不良反应，特别是有没有婴儿鹅口疮的评估报告。研究中亦没有系统地收集细菌抗药性的数据。研究结果显示在选择性或紧急剖腹产手术，在夹住脐带之前或之后给予抗生素的效果是类似的。总体而言，研究方法的品质上并不清楚，只有少数研究清楚地指出潜在的偏差来源。

作者结论
预防性抗生素的使用减少了三分之二至四分之三的子宫内膜炎，也减少了伤口感染的发生。然而，对于潜在的不良影响，包括抗生素使用对婴儿的影响，并没有完整的资料收集，使得整体利益和损害的评估变得复杂。预防性抗生素对所有接受选择性或紧急剖腹产的妇女显然是有益的，但​​对婴儿的影响则不确定。

翻译人
本摘要由屏东基督教医院赵珮娟翻译。

此翻译计画由台湾国家卫生研究院(National Health Research Institutes, Taiwan) 统筹。

总结
常规抗生素的使用对于减少剖腹产感染：妇女接受剖腹产发生感染的机会为自然产的5至20倍。这些感染可发生在骨盆腔内的器官,手术伤口周围，或尿路感染。感染程度可以很严重，少数时候会导致母亲的死亡。使用抗生素以减少感染的潜在好处需和其不利影响相权衡，如母亲发生恶心，呕吐，皮肤红疹，少数会有过敏反应，鹅口疮，影响婴儿肠道中的'好菌' 。这一篇回顾探讨抗生素的使用对预防选择性和紧急剖腹产手术感染是否有效，并且研究了的效果。回顾包含1万3千名妇女的86个研究发现常规使用抗生素降低剖腹产后发烧，伤口'子宫及尿路感染的风险，也减少了母亲并发严重感染的风险。不管是选择性或紧急剖腹产手术，在夹住脐带之前或之后给予抗生素皆有此效果。但是，没有研究探究使用抗生素对婴儿可能产生的不利影响，例如是否增加了发生鹅口疮的风险，也不清楚在剖腹产时常规使用抗生素是否和抗药性菌株的增加有关。在这两方面的影响需要进一步的研究。