Meta分析抗生素对TURP术后感染性并发症的预防效果

目的　分析预防性抗生素能否减少术前为清洁尿、行经尿道前列腺切除术 (TURP)患者的术后感染性并发症。　方法　制定原始文献的纳入标准、排除标准及检索策略 ,在美国医学索引(MEDLINE)、荷兰医学文摘 (EMBASE)药理学分册、中国生物医学文摘 (CBMA)、及Cochrane图书馆(CL)内进行相关的随机对照试验的检索、质量评价和资料提取。应用RevMan软件进行数据处理 ;计数资料的效应尺度以相对危险度 (RR)及其 95 %可信区间 (95 %CI)表示 ;计量资料的效应尺度以加权均数差 (WMD)及其 95 %CI表示。　结果　共检索到相关随机对照试验 5 3篇 ,排除 2 6篇 ,符合纳入标准 2 7篇进入Meta分析。结果表明 :术前清洁尿的患者 ,预防性抗生素能显著降低TURP术后 1周内菌尿、术后发热、菌血症的发生率和术后需继续抗生素治疗的比率 ,RR值及其 95 %CI分别为 0 .36(0 .2 8～ 0 .4 6 )、0 .83(0 .71～ 0 .97)、0 .4 3(0 .2 2～ 0 .86 )及 0 .2 6 (0 .2 0～ 0 .33) ;但尚不能确定预防性抗生素能否缩短患者住院时间 ,其WMD及 95 %CI为 - 0 .31(- 0 .78～ 0 .35 )。　结论　术前为清洁尿的患者 ,预防性应用抗生素能减少TURP术后菌尿、发热、菌血症的发生率和术后需继续抗生素治疗的比率 ;尚不能确定能否缩短术后住院时间。

Antibiotic prophylaxis for postoperative infective complications in patients undergoing TURP:systematic evaluation of the preventive effect

Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in patients undergoing TURP who have sterile preoperative urine. Methods MEDLINE,EMBASE,CBMA and the Cochrane Library were searched for RCTs comparing antibiotic prophylaxis with placebo/blank controls for patients undergoing TURP with preoperative sterile urine.The search strategy was made according to the Collaborative Review Group search strategy.Data were extracted by two reviewers using the designed extraction form. The software RevMan was used to review management and data analysis.The results were expressed as RR and 95% confidence intervals (CI) for categorical outcomes and weighted mean difference (WMD) and 95%CI for continuous outcomes. Results 53 relevant RCTs were searched, of which 27 were included and 26 were excluded.Antibiotic prophylaxis significantly decreased the rate of post-TURP bacteriuria,post-TURP fever,post-TURP bacteremia and the rate of continuous antibiotic use.The corresponding pooled relative risk (RR) and 95%CI was 0.36 (0.28 to 0.46),0.83 (0.71 to 0.97),0.43 (0.22 to 0.86) and 0.26 (0.20 to 0.33),respectively.However,the available data failed to prove that antibiotic prophylaxis shortened the duration of hospitalization (WMD, -0.31;95% CI , -0.78 to 0.35). Conclusions Prophylactic antibiotics can significantly decrease the incidence of post-TURP bacteriuria,fever,bacteremia and continuous antibiotic treatment,but cannot significantly shorten the duration of hospitalization.Antibiotics should be used in patients undergoing TURP.