乳腺癌手术预防应用抗菌药物对降低手术部位感染的作用

目的 明确预防应用抗菌药物对乳腺癌手术后手术部位感染发病率的影响.方法 通过检索Medline、Embase和Cochrane图书馆数据库,筛选2011年12月之的公开发表的文献,无语言限制；选择标准为乳腺癌患者接受围手术期抗菌药物的随机对照试验、研究结局为手术部位感染；数据收集和分析由作者审查检索的所有研究的标题和摘要,然后评估研究质量,并从符合纳入标准的研究中提取数据.结果 共纳入了8项研究,所有研究干预组均为抗菌药物,对照组为安慰剂或空白对照,而且均为高质量随机对照研究；研究结果表明,乳腺癌手术患者围手术期预防应用抗菌药物可显著降低手术部位感染率(RR=0.71,95％CI:0.55～0.92);经过Begg's检验(z=0.12,P-0.90)和Egger's检验(t=0.16,P=0.88),该研究不存在明显的发表偏倚.结论 预防应用抗菌药物可降低乳腺癌手术后手术部位感染发病率,但需权衡考虑感染引起的潜在风险如伤口愈合或延迟质量和用药引起的不良后果如成本、药物反应或增加细菌耐药性等.

Antibiotic prophylaxis in prevention of surgical site infections after breast cancer surgery

OBJECTIVE To determine the effect of antibiotic prophylaxis on the incidence of surgical site infections after breast cancer surgery.METHODS We searched the Cochrane Library,Ovid MEDLINE and EMBASE to select articles published before Dec 2011.No language restrictions were applied.Randomized controlled trials of pre and peri-operative antibiotics for patients undergoing surgery for breast cancer were included.Primary outcomes were incidence of breast wound infections.The authors examined the titles and Abstracts of all studies identified by the search strategy,then assessed study quality and extracted data from those that met the inclusion criteria.RESULTS A total of eight studies were included in the review.All eight evaluated pre-operative antibiotic compared with no antibiotic or placebo,and all of them had high quality as randomized controlled trial.The results demonstrated that prophylactic antibiotics significantly reduced the incidence of surgical site infections for the patients undergoing breast cancer surgery(pooled RR= 0.71,95% CI:0.55 to 0.92);through the Begg′s test(z=0.12,P=0.90) and Egger′s test(t=0.16,P=0.88),there were no obvious publication bias.CONCLUSION Prophylactic antibiotics may reduce the incidence of surgical site infections in the patients undergoing breast cancer surgery.The potential risks caused by the infections,such as the increase in the cost,drug reaction and the bacterial resistance due to the delay in wound healing or adjuvant antibiotics,must be weighed.