Summary of findings for the main comparison. Antibiotic prophylaxis versus no antibiotic prophylaxis / standard care for CSF‐shunt infections.
| Antibiotic prophylaxis versus no antibiotic prophylaxis / standard care for CSF‐shunt infections | ||||||
| Patient or population: CSF‐shunt infections Setting: Hospital Intervention: antibiotic prophylaxis Comparison: no antibiotic prophylaxis / standard care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no antibiotic prophylaxis / standard care | Risk with antibiotic prophylaxis | |||||
| Number of participants experiencing shunt infection after administration of antibiotic prophylaxis follow up: mean 6.4 months | Study population | RR 0.55 (0.36 to 0.84) | 1109 (11 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 118 per 1.000 | 65 per 1.000 (43 to 99) | |||||
| Number of participants experiencing shunt infection after administration of intravenous antibiotic prophylaxis follow up: mean 5.5 months | Study population | RR 0.55 (0.33 to 0.90) | 797 (8 RCTs) | ⊕⊕⊝⊝ LOW 3 4 | ||
| 116 per 1.000 | 64 per 1.000 (38 to 104) | |||||
| Number of participants experiencing shunt infection after administration of intrathecal antibiotic prophylaxis follow up: mean 10 months | Study population | RR 0.73 (0.28 to 1.93) | 202 (2 RCTs) | ⊕⊕⊝⊝ LOW 5 | ||
| 100 per 1.000 | 73 per 1.000 (28 to 193) | |||||
| Number of participants experiencing shunt infection after implantation of antibiotic impregnated catheters follow up: median 9 months | Study population | RR 0.36 (0.10 to 1.24) | 110 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 6 7 | ||
| 167 per 1.000 | 60 per 1.000 (17 to 207) | |||||
| *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; RR: Risk ratio; 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 | ||||||
1 Downgraded one level due to indirectness of evidence, since control groups differed a lot. For example, one study compared the used of antibiotic prophylaxis to current practice in a multicenter design.
2 Downgraded one level because four studies were considered at serious risk of bias at at least three forms of bias
3 Downgraded one level due to indirectness of evidence, since control groups differed a lot.
4 Downgraded one level because two studies were considered at serious risk of bias at at least three forms of bias
5 Downgraded two levels because both studies were considered at serious risk of bias at at least three forms of bias
6 Downgraded two levels because the study was considered at serious or unclear risk of bias at five out of seven items
7 Downgraded one level, since only one study was included in this subgroup and the total number of participants in this study was low