| 预防性应用抗菌药物预防乳腺癌术后手术部位感染的荟萃分析 |
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| 引用本文： | 孙晓寅,莊志刚.预防性应用抗菌药物预防乳腺癌术后手术部位感染的荟萃分析[J].现代肿瘤医学,2019,0(13):2318-2322. |
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| 作者姓名： | 孙晓寅 莊志刚 |
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| 作者单位： | 同济大学附属第一妇婴保健院乳腺科，上海 201204 |
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| 基金项目： | 上海市科委西医引导类项目（编号:15411964800）；上海市卫计委面上项目（编号:201640084） |
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| 摘 要： | 目的:探讨预防性应用抗菌药物对乳腺癌术后手术部位感染的预防作用。方法:以“preoperative antibiotics/peri-operative antibiotics/prophylactic antibiotics”、“surgical site infection/wound infection/postoperative complications”、“mastectomy/wide local excision/breast reconstruction/axillary dissection”为关键词,查找1966年至2016年PubMed、Cochrane Library、Embase、ScienceDirect、Wiley InterScience、Scopus和Ovid数据库的RCT,无语言限制。2位评价者评价每一项研究的质量并提取数据。结果:12项RCT共计4 267例患者被纳入该荟萃分析。分析发现,预防性使用抗菌药物组可以显著降低手术部位感染(OR=0.63,95%CI:0.49~0.81, P =0.000 2)。按不同给药方式做亚组分析后,发现采用静脉抗生素的亚组,SSI的累积发生率(5.5%)显著低于对照组(8.2%)(OR=0.65,95%CI:0.50~0.83, P =0.000 7);按不同用药方案做亚组分析后,发现使用头孢地尼预防抗感染组发生SSI的累积发生率显著低于对照组(OR=0.54,95%CI:0.30~0.94, P =0.03)。结论:预防性使用抗菌药物可预防乳腺术后SSI的发生,进一步亚组分析提示采用静脉抗菌药物预防效果更佳,但由于亚组研究数量有限,仍需要更多高质量的RCT提供依据以建立最有效的预防方案和标准流程。
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| 关 键 词： | 预防性抗菌药物 乳腺癌术后 手术部位感染 |
Effectiveness of prophylactic antibiotics to prevent surgical site infection after breast cancer surgery:A Meta-analysis |
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| Sun Xiaoyin,Zhuang Zhigang.Effectiveness of prophylactic antibiotics to prevent surgical site infection after breast cancer surgery:A Meta-analysis[J].Journal of Modern Oncology,2019,0(13):2318-2322. |
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| Authors: | Sun Xiaoyin Zhuang Zhigang |
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| Affiliation: | Department of Breast Surgery，Shanghai First Maternity and Infant Hospital，Tongji University School of Medicine，Shanghai 201204，China. |
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| Abstract: | Objective:To assess the preventive effect of prophylactic (pre-or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery.Methods:We searched PubMed，Cochrane Library，Embase，ScienceDirect，Wiley InterScience，Scopus and Ovid with medical subject headings including ' preoperative antibiotics/peri-operative antibiotics/prophylactic antibiotics'，' surgical site infection/wound infection/postoperative complications'，' mastectomy/wide local excision/breast reconstruction/axillary dissection' from 1966 to 2016 for RCTs.Results:12 trials with a total of 4 267 patients were identified，with the overall effect of antibiotics showing benefit for preventing SSI (OR=0.63，95%CI:0.49~0.81,P=0.000 2).The cumulative incidence of SSI in patients used intravenous antibiotics was 5.5%，which was lower than that in patients not used (8.2%)(OR=0.65,95%CI:0.50~0.83,P=0.000 7).The cumulative incidence of SSI in cefonicid group was lower than non-antibiotics group (OR=0.54,95%CI:0.30~0.94,P=0.03).Conclusion:The overall effect of prophylactic antibiotics treatment seems to be helpful for prevention of SSI.Subgroup analysis shows antibiotics benefits only by intravenous injection.The limited studies on subgroup analysis mean that only a limited conclusion on the use of antibiotic for prevention of SSI is possible. |
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| Keywords: | prophylactic antibiotics breast surgery surgical site infection |
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