Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
- Types of studiesAll randomized clinical trials (RCTs). Nonrandomized and quasirandomized trials were excluded. Studies where it was not possible to obtain the complete manuscript were excluded.
- Types of participantsPatients undergoing laparoscopic colorectal surgery.
- Types of interventions and comparisonOral and parenteral antibiotic prophylaxis vs. parenteral-only prophylaxis.
- Types of outcome measuresPrimary outcomes: SSIs. Secondary outcomes: other infectious and noninfectious postoperative complications. Studies with no outcome of interest were excluded.
2.2. Search Strategy
2.3. Selection Process
2.4. Data Collection Process
2.5. Risk of Bias Assessment
- Bias arising from the randomization process;
- Bias due to deviations from intended interventions;
- Bias due to missing outcome data;
- Bias in measurement of the outcome;
- Bias in selection of the reported result.
2.6. Statistical Analysis
2.7. Certainty Assessment
3. Results
3.1. Study Selection
3.2. Risk of Bias Assessment
3.3. Surgical Site Infections
3.4. Anastomotic Leakage
3.5. Enteritis/Colitis
3.6. Pneumonia
3.7. Urinary Tract Disorder
3.8. Bowel Obstruction
3.9. Certainty Assessment
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Abbreviations
Appendix A. Search Strategy
Database | Date of Search | Search Strategy |
---|---|---|
Cochrane Central Register of Controlled Trials (Central) | 1 May 2021, updated 6 December 2021 | #1 MeSH descriptor: [Laparoscopy] explode all trees #2 MeSH descriptor: [Colorectal Neoplasms] explode all trees #3 MeSH descriptor: [Antibiotic Prophylaxis] explode all trees #4 MeSH descriptor: [Surgical Wound Infection] explode all trees #5 Laparoscop * AND Colorectal neoplasm* #6 antibiotic * OR prophyla* #7 #1 AND #2 #8 #5 OR #7 #9 #3 OR #6 #10 surgical wound * OR wound * infection * #11 #4 OR #10 #12 #8 AND #9 #11 |
PUBMED (Ovid SP) | 1 May 2021, updated 6 December 2021 | (1) “laparoscopie”[All Fields] OR “laparoscopy”[MeSH Terms] OR “laparoscopy”[All Fields] OR “laparoscopies”[All Fields] (2) “colorectal neoplasms”[MeSH Terms] OR (“colorectal”[All Fields] AND “neoplasms”[All Fields]) OR “colorectal neoplasms”[All Fields] OR (“colorectal”[All Fields] AND “neoplasm”[All Fields]) OR “colorectal neoplasm”[All Fields] (3) “antibiotic prophylaxis”[MeSH Terms] OR (“antibiotic”[All Fields] AND “prophylaxis”[All Fields]) OR “antibiotic prophylaxis”[All Fields] (4) “oral”[All Fields] OR “mouth”[MeSH Terms] OR “mouth”[All Fields] (5) “infusions, parenteral”[MeSH Terms] OR (“infusions”[All Fields] AND “parenteral”[All Fields]) OR “parenteral infusions”[All Fields] OR (“infusions”[All Fields] AND “parenteral”[All Fields]) OR “infusions, parenteral”[All Fields] (6) “surgical wound infection”[MeSH Terms] OR (“surgical”[All Fields] AND “wound”[All Fields] AND “infection”[All Fields]) OR “surgical wound infection”[All Fields] (7) 1 AND 2 (8) 3 OR 4 OR 5 (9) 7 AND 8 AND 6 |
EMBASE (Ovid SP) | 1 May 2021, updated 6 December 2021 | 1. “laparoscopie”[All Fields] OR “laparoscopy”[MeSH Terms] OR “laparoscopy”[All Fields] OR “laparoscopies”[All Fields] 2. “colorectal neoplasms”[MeSH Terms] OR (“colorectal”[All Fields] AND “neoplasms”[All Fields]) OR “colorectal neoplasms”[All Fields] OR (“colorectal”[All Fields] AND “neoplasm”[All Fields]) OR “colorectal neoplasm”[All Fields] 3. “antibiotic prophylaxis”[MeSH Terms] OR (“antibiotic”[All Fields] AND “prophylaxis”[All Fields]) OR “antibiotic prophylaxis”[All Fields] 4. “oral”[All Fields] OR “mouth”[MeSH Terms] OR “mouth”[All Fields] 5. “infusions, parenteral”[MeSH Terms] OR (“infusions”[All Fields] AND “parenteral”[All Fields]) OR “parenteral infusions”[All Fields] OR (“infusions”[All Fields] AND “parenteral”[All Fields]) OR “infusions, parenteral”[All Fields] 6. “surgical wound infection”[MeSH Terms] OR (“surgical”[All Fields] AND “wound”[All Fields] AND “infection”[All Fields]) OR “surgical wound infection”[All Fields] 7. 1 AND 2 8. 3 OR 4 OR 5 9. 7 AND 8 AND 6 |
Science Citation Index Expanded | 6 December 2021 | # 5 #4 AND #3 # 4 TS=(surgical wound infection *) # 3 #2 AND #1 # 2 TS=(laparoscop * and colorectal neoplasm *) # 1 TS=(antibiotic * or prophyla * or oral or parenteral) |
Ishida 2001 | |
Risk of bias arising from the randomization process | Some concerns |
Risk of bias due to deviations from the intended interventions | Low |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | High |
Risk of bias in selection of the reported result | Some concerns |
Overall risk of bias | High |
Kobayashi 2007 | |
Risk of bias arising from the randomization process | Low |
Risk of bias due to deviations from the intended interventions | Some concerns |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | High |
Risk of bias in selection of the reported result | High |
Overall risk of bias | High |
Ikeda 2016 | |
Risk of bias arising from the randomization process | Low |
Risk of bias due to deviations from the intended interventions | Low |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | Low |
Risk of bias in selection of the reported result | Low |
Overall risk of bias | Low |
Hata 2016 | |
Risk of bias arising from the randomization process | Low |
Risk of bias due to deviations from the intended interventions | Some concerns |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | Low |
Risk of bias in selection of the reported result | Low |
Overall risk of bias | Some concerns |
Abis 2019 | |
Risk of bias arising from the randomization process | Low |
Risk of bias due to deviations from the intended interventions | Some concerns |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | Low |
Risk of bias in selection of the reported result | Low |
Overall risk of bias | Some concerns |
Schardey 2020 | |
Risk of bias arising from the randomization process | Low |
Risk of bias due to deviations from the intended interventions | Low |
Bias due to missing outcome data | Low |
Risk of bias in measurement of the outcome | Some concerns |
Risk of bias in selection of the reported result | High |
Overall risk of bias | High |
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Study | Design | Total N | Intervention (Oral + IV) N | Control (IV-Only) N | Primary Outcome | Secondary Outcome | Oral Antibiotics | IV Antibiotics | Type of Resection |
---|---|---|---|---|---|---|---|---|---|
Ishida 2001 [36] | RCT | 143 | 72 | 71 | SSI | Anastomotic leak, Enteritis/colitis, Pneumonia | Kanamycin 500 mg + Erythromycin 400 mg in 4 daily doses, started 2 days preoperatively + control group treatment | Cefotiam 1 g in 2 daily doses for 48 h |
Colectomy—76 Anterior resection—47 APR—9 Total proctectomy with J pouch—3 Total pelvic exenteration—4 Other—4 |
Kobayashi 2007 [39] | RCT | 484 | 242 | 242 | SSI | / | Kanamycin 1 g + Erythromycin 400 mg at 14:00, 15:00, and 23:00 + control group treatment |
Cefmetazole 1 g after the induction of anesthesia, additional dose if the operation was prolonged beyond 3 h. Again twice daily for 3 |
Surgical procedure: Colon—241 Rectum—243 |
Ikeda 2016 [34] | RCT | 511 | 255 | 256 | SSI | Anastomotic leak, Enteritis/colitis, Urinary tract disorder, Bowel obstruction | Kanamycin 1000 mg 2 doses + Metronidazole 750 mg, started 1 day preoperative + control group treatment | Cefmetazole 1 g 3 doses in 24 h |
Colonic surgery—309 Anterior resection—177 APR—25 |
Hata 2016 [35] | RCT | 579 | 289 | 290 | SSI | Anastomotic leak, Enteritis/colitis; Pneumonia, Urinary tract disorder, Bowel obstruction | Kanamycin 1 g + Metronidazole 750 mg at 13 h and 9 h before the surgery + control group treatment | Cefmetazole 1 g was administered intravenously 30 min before the skin incision, additional dose was given every 3 h during the surgery |
Colectomy—376 Anterior resection—183 APR—20 |
Abis 2019 [37] | RCT | 455 | 228 | 227 | SSI | Anastomotic leak, Pneumonia, Urinary tract disorder, Bowel obstruction | SDD 3 days prior to surgery until 3 days after surgery or when normal bowel motion occurred + control group treatment | Cefazoline 1 g + Metronidazole 500 mg, intravenously, 30 min prior to skin incision |
Right hemicolectomy—162 Transverse colectomy—17 Left hemicolectomy—41 Sigmoid resection—124 Low anterior resection—103 Other—8 |
Schardey 2020 [38] | RCT | 80 | 40 | 40 | SSI | Anastomotic leak, Pneumonia, Enteritis/colitis, Urinary tract disorder | Polymyxin B sulphate 100 mg + Tobramycin 80 mg + Vancomycin 125 mg + Amphotericin B 500 mg 4 daily doses, started 1 day preoperatively until day 7 postoperatively. | Amphotericin B 500 mg + Lactulose 305 mg | Low anterior resection with TME—80 |
Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection | |||||
---|---|---|---|---|---|
Patient or population: Patients undergoing laparoscopic colorectal resection Setting: Multicentered study Intervention: Oral and parenteral antibiotic prophylaxis Comparison: Parenteral antibiotic prophylaxis only | |||||
Outcomes | № of Participants (Studies) Follow-Up | Certainty of the Evidence (GRADE) | Relative Effect (95% CI) | Anticipated Absolute Effects | |
Risk with Parenteral Antibiotic Prophylaxis | Risk Difference with Oral and Parenteral Antibiotic Prophylaxis | ||||
Overall Surgical Site Infections | 2252 (6 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.54 (0.40 to 0.72) | 113 per 1000 | 49 fewer per 1000 (64 fewer to 29 fewer) |
Incisional Surgical Site Infections | 1717 (4 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.61 (0.41 to 0.90) | 78 per 1000 | 29 fewer per 1000 (44 fewer to 7 fewer) |
Organ/space Surgical Site Infections | 1717 (4 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.79 (0.47 to 1.32) | 40 per 1000 | 8 fewer per 1000 21 fewer to 12 more) |
Anastomotic Leakage | 1768 (5 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.55 (0.33 to 0.91) | 50 per 1000 | 22 fewer per 1000 (33 fewer to 4 fewer) |
Enteritis/colitis | 1313 (4 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.67 (0.30 to 1.48) | 23 per 1000 | 7 fewer per 1000 (16 fewer to 11 more) |
Pneumonia | 1257 (4 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.75 (0.39 to 1.45) | 33 per 1000 | 8 fewer per 1000 (20 fewer to 14 more) |
Urinary Tract Disorder | 1625 (4 RCTs) | ⨁⨁⨁◯ Moderate | OR 0.73 (0.36 to 1.47) | 22 per 1000 | 6 fewer per 1000 (14 fewer to 10 more) |
Bowel Obstruction | 1545 (3 RCTs) | ⨁⨁◯ ◯ Low | OR 0.76 (0.44 to 1.32) | 39 per 1000 | 9 fewer per 1000 (21 fewer to 12 more) |
The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio | |||||
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. |
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Sangiorgio, G.; Vacante, M.; Basile, F.; Biondi, A. Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis. Antibiotics 2022, 11, 21. https://doi.org/10.3390/antibiotics11010021
Sangiorgio G, Vacante M, Basile F, Biondi A. Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis. Antibiotics. 2022; 11(1):21. https://doi.org/10.3390/antibiotics11010021
Chicago/Turabian StyleSangiorgio, Giuseppe, Marco Vacante, Francesco Basile, and Antonio Biondi. 2022. "Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis" Antibiotics 11, no. 1: 21. https://doi.org/10.3390/antibiotics11010021