Table 2.
Baseline characteristics of included studies regarding country, type of surgery, prophylactic antibiotics, gender, mean age, number of subjects, outcome measure, study design, antibiotic susceptibility, and prophylactic timing.
| Author, year | Country | Type of surgery | Prophylactic antibiotic | Gender | Mean age (years) | Number of subject | Outcome measure | Study design | Antibiotic susceptibility | Prophylactic timing | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Study group | Control group | ||||||||||
| GENERAL SURGERY | |||||||||||
| Chaudhuri et al., 2006 | Germany | Excision of pilonidal sinuses | Metronidazole 500 mg i.v. | Cefuroxime 1.5 g i.v.+ metronidazole 500 mg i.v. | F and M | 27 | SG: 25; CG: 25 |
Infection related wound complications, total costs | Double-blinded RCT | NA | 30 min prior to incision and continued to day 5 for multi-drug |
| Wilson et al., 2008 | United States | Elective colorectal surgery | Ertapenem 1 g i.v. | Cefotetan 2 g i.v. | F and M | SG: 61.3; CG: 60.2 |
SG: 338; CG: 334 |
SSIs, antibiotic use, anastomotic leak of the bowel, cost per dose, direct medical costs | Observational study: analysis from PREVENT trial (Itani et al., 2006) | NA | 30 min prior to incision |
| Matsui et al., 2014 | United States | Laparoscopic cholecystectomy | Cefazolin sodium 1 g i.v. | Without prophylactic antibiotics | F and M | Over 65: 197 patients (SG) and 202 patients (CG) | SG: 518; CG: 519 |
Postoperative infections (SSIs, distant infections), hospital stay, antibiotic costs, direct medical costs | RCT | NA | Before skin incision |
| Singh et al., 2014 | United States | Abdominal surgery | Triclosan-coated sutures | Without triclosan-coated sutures | NA | All ages included | 1,000 individuals | Cost saving of triclosan-coated sutures when SSI-risks were 5, 10, and 15% | Model-based study | NA | NA |
| Ozdemir et al., 2016 | Turkey | Elective colorectal resections | Cefazolin 1 g i.v. and metronidazole 500 mg i.v. plus metronidazole 4 g p.o. + gentamicin 480 mg p.o. | Cefazolin 1 g i.v. and metronidazole 500 mg i.v. | F and M | SG: 58; CG: 59 |
SG: 45; CG:45 |
SSIs, length of hospital stays, cost saving | Retrospective study | NA | Start from during anesthesia induction to 5 days post-operation |
| ORTHOPEDIC | |||||||||||
| Elliott et al., 2010 | United Kingdom | Primary hip arthroplasty | Cephalosporin | Vancomycin or combination of vancomycin and cephalosporin | M | 65 | 1,770 | SSIs, MRSA infection, length of stay, mortality, utility in QALYs, costs | Model-based study | NA | NA |
| Courville et al., 2012 | United States | Total hip and knee arthroplasty | Nasal mupirocin | Without mupirocin | NA | Hypothetical cohort of 65-year-old | NA | SSIs, utility in QALYs, costs | Model-based study | NA | NA |
| Merollini et al., 2013 | Australia | Total hip arthroplasty | Antibiotic prophylaxis | No antibiotic prophylaxis, antibiotic-impregnated cement, laminar air operating rooms. | NA | 65 years | 30,000 hypothetical cohorts | SSIs, utility in QALYs, length of stay, mortality | Decision model and cost effectiveness analysis | NA | NA |
| Theologis et al., 2014 | United States | Thoracolumbar adult deformity reconstruction | Intravenous antibiotics and vancomycin powder 2 g | Intravenous antibiotics | F and M | SG: 62.4; CG: 60.0 |
SG: 151; CG: 64 |
SSIs, utility in QALYs, add-on impregnated prophylactic antibiotic cost, cost saving | Retrospective cohort study | NA | NA |
| Graves et al., 2016 | United States | Primary hip replacement | No systemic antibiotics | Systemic antibiotics | NA | NA | 77,321 | Deep infections, utility in QALYs, costs | Model-based study | NA | NA |
| Ceballos et al., 2017 | Colombia | Lower limb amputation | Cefazolin, cephalothin, cefotaxime, cefoxitin, cefuroxime | Non-prophylactic antibiotics | NA | NA | 10,000 simulations | Decision analytic model of superficial and deep infections, healing, sepsis, re-amputation, mortality, costs | Model-based study | NA | NA |
| NEUROSURGERY | |||||||||||
| Emohare et al., 2014 | United States | Posterior spinal surgery | Cefazolin i.v. and vancomycin powder 1 g intra-wound | Cefazolin i.v. | F and M | SG: 53.7; CG: 58.2 |
SG: 96; CG: 207 |
SSIs, intra-wound costs, direct costs | Retrospective cohort study | NA | NA |
| Lewis et al., 2016 | United States | Cranial surgery and subdural or subgaleal drains | PPSAs of Cefazolin and Vancomycin | Non-PPSAs | F and M | SG: 59; CG: 57 |
SG: 105; CG: 80 |
SSIs, direct costs and cost saving | Retrospective study | NA | NA |
| CARDIOTHORACIC SURGERY | |||||||||||
| Dhadwal et al., 2007 | United Kingdom | Coronary artery bypass grafting surgery | Rifampicin 600 mg p.o., gentamicin 2 mg/kg i.v. and vancomycin 15 mg/kg i.v. | Cefuroxime 1.5 g i.v. | F and M | SG: 62.8; CG: 65.4 |
SG: 87; CG: 99 |
SWIs, antibiotic and hospital costs | Double-blinded RCT | NA | Rifampicin 1 h preoperatively, gentamicin and vancomycin after anesthesia induction |
| Joshi et al., 2016 | United Kingdom | Cardiac surgery in high risk of SWI | Gentamicin-impregnated collagen sponges | Without gentamicin-impregnated collagen sponges | NA | NA | 1251 | SWI incidence, median postoperative cost, annual additional cost for SWIs and the gentamicin-impregnated collagen sponges | Observational study | NA | NA |
| OBSTETRIC GYNECOLOGICAL SURGERY | |||||||||||
| Alekwe et al., 2008 | Nigeria | Elective cesarean section | Ceftriaxone 1 g i.v. | Ampicillin/ cloxacillin 1 g q.i.d. i.v., gentamicin 80 mg t.i.d. i.v. and metronidazole 500mg t.i.d. i.v. | F | SG: 33.53; CG: 32.08 |
SG: 100; CG: 100 |
Infectious morbidity, endometritis, UTI, febrile morbidities, wound infections, duration of hospital stay, antibiotic costs | RCT | NA | NA |
| Kosus et al., 2010 | Turkey | Cesarean section | Ceftriaxone 1 g i.v. and rifamycin 250mg | Ceftriaxone 1 g i.v. | F | SG: 28.4; CG: 26.8 |
SG: 596; CG: 600 |
SSI rates, cost for rifamycin and SSI treatments | RCT | NA | NA |
| ONCOLOGIC SURGERY | |||||||||||
| Patil et al., 2011 | India | Head and neck onco-surgeries | Single antibiotic of cefazolin, or ciprofloxacin, or cefprozil, or clindamycin | Combination antibiotics of cefazolin and metronidazole, or clindamycin and gentamicin, or ampicillin/ cloxacillin, or moxifloxacin and metronidazole, or ciprofloxacin and metronidazole, or cefprozil and metronidazole | F and M | NA | 50 | Post-operative wound infections, costs for prophylactic antibiotics and post-operative antibiotics | Observational study | NA | NA |
| Gulluoglu et al., 2013 | Turkey | Breast cancer surgery | Ampicillin-sulbactam 1 g i.v. | Without prophylactic antibiotics | F | SG: 58.8; CG: 58.2 |
SG: 187; CG: 182 |
SSIs, time to SSIs, culture results, adverse reactions due to antibiotics, mean SSI-related costs | RCT | NA | NA |
| El-Mahallawy et al., 2013 | Egypt | Cancer surgery (bladder, stomach, colon, rectum) | Penicillin G sodium 4,000,000 IU i.v. and gentamicin 80 mg i.v. | Clindamycin 600 mg i.v. and amikacin 500 mg i.v. | F and M | ≤ 40 years: 72; >40 years: 128 | SG: 100; CG: 100 |
SSI incidence and cost for prophylactic antibiotics | RCT | NA | NA |
CG, control Group; F, female; i.v., intravenous; M, male; MRSA, Methicillin-resistance Staphylococcus aureus; NA, not available; p.o., per oral; PPSAs, prolonged prophylactic systemic antibiotics; QALYs, quality adjusted life years; q.i.d., quarter in die (four times a day); RCT, randomized control trial; SG, study group; SSIs, surgical site infections; SWIs, sternal wound infections; t.i.d., ter in die (three times a day); UTI, urinary tract infection.