Table 3.
Comparative studies evaluating the preferable type of antibiotic in the prevention of surgical site infections
| Article | Study type | Antibiotic regimen | Duration | Rate SSI | p value | Odds ratio, confidence interval |
|---|---|---|---|---|---|---|
| Robbins et al. (1988) [35] | RCT (n = 330) | Cefazolin–metronidazole (n = 158) | < 5 days (n = 306) | 11.9% | < 0.05* | N/A |
| Cefazolin (n = 172) | > 5 days (n = 24) | 23.9% | ||||
| Swanson et al. (1991) [40] | RCT (n = 99) | Cefonicid (n = 50) | 1 day (n = 99) | 24% | < 0.05* | N/A |
| Clindamycin (n = 49) | 8.2% | |||||
| Phan et al. (1992) [37] | RCT (n = 99) | Ampicillin–sulbactam (n = 42) | 1 day (n = 99) | 33% | 0.19 | N/A |
| Clindamycin-amikacin (n = 43) | 21% | |||||
| Weber et al. (1992) [41] | RCT (n = 212) | Ampicillin–sulbactam (n = 105) | 1 day (n = 212) | 13.3% | < 0.05* | OR = 0.41, 95% CI 0.2–0.84 |
| Clindamycin (n = 107) | 27.1% | OR = 1.00 | ||||
| Rodrigo et al. (1997) [18] | RCT (n = 159) | Amoxicillin–clavulanate (n = 57) | 1 day (n = 159) | 22.8% | 0.8 | N/A |
| Clindamycin–gentamicin (n = 52) | 21.2% | |||||
| Cefazolin (n = 50) | 26% | |||||
| Johnson et al. (1997) [42] | RCT (n = 169) | Ampicillin–sulbactam (n = 81) | 1 day (n = 169) | 14% | 0.92 | OR = 1.00 |
| Clindamycin (n = 88) | 14% | OR = 0.96, 95% CI 0.45–2.407 | ||||
| Callender (1999) [43] | RCT (n = 212) | Clindamycin (n = 107) | 2 days (n = 212) | 27.1% | 0.02* | N/A |
| Ampicillin–sulbactam (n = 105) | 13.3% | |||||
| Skitarelic et al. (2007) [27] | RCT (n = 189) | Cefazolin (n = 92) | 24 h (n = 155) | 24% | > 0.05 | N/A |
| Amoxicillin–clavulanate (n = 97) | 21% | |||||
| Mücke et al. (2015) [24] | OBS (n = 350) | Amoxicillin–sulbactam (n = 88) | 10 days (n = 350) | 19.3% | 0.018* | OR = 0.29, 95% CI 0.1–0.81 |
| Benzylpenicillin (n = 122) | 27% | 0.11 | OR = 0.45, 95% CI 0.17–1.19 | |||
| Cefuroxime (n = 120) | 20.8% | 0.034* | OR = 0.35, 95% CI 0.13–0.92 | |||
| 50% | OR = 1.00 | |||||
| Placebo (n = 20) | ||||||
| Mitchell et al. (2015) [25] | OBS (n = 427) | Ampicillin–sulbactam (n = 227) | < 24 h (n = 96) | Overal SSI rate 21.8% | 0.01* | OR = 1.00 |
| Clindamycin (n = 156) | OR = 2.54, 95% CI 1.25–5.14 | |||||
| Other (n = 44) | > 24 h (n = 331) | OR = 0.84 | ||||
| Langerman et al. (2015) [10] | OBS (n = 1865) | Standard antibiotics (n = 836)b | < 4 days (n = 585) | 5.1% | N/A | OR = 1.00 |
| Clindamycin (n = 287) | 17.4% | OR = 3.87, 95% CI 2.31–6.49 | ||||
| Clindamycin + other (n = 166) | > 4 days (n = 1280) | 11.4% | OR = 2.69, 95% CI 1.43–5.05 | |||
| Non-standard antibioticsb (n = 444) | 5.0% | OR = 0.95, 95% CI 0.53–1.69 | ||||
| 12.9% | ||||||
| Placebo (n = 132) | OR = 2.17, 95% CI 1.06–4.14 | |||||
| Khariwala et al. (2016) [34] | OBS (n = 149) | Cephalosporins (n = 10) | < 2 days (n = 64) | Overall SSI rate 22.2% | 1.00 | N/A |
| Penicillins (n = 107) | > 2 days | 0.04* | ||||
| Quinolones (n = 4) | (n = 85) | 0.21 | ||||
| Clindamycin (n = 25) | 0.02* | |||||
| Pool et al. (2016) [19] | OBS (n = 266) | Standard antibiotics (n = 255)a | N/A | 8% | 0.01* | OR = 1.00 |
| Non-standard antibioticsa (n = 41) | 27% | OR = 3.78, 95% CI 1.4–10.5 | ||||
| Murphy et al. (2017) [44] | OBS (n = 102) | Ampicillin–sulbactam (n = 58) | 12 days | 28% | OR = 1.00 | |
| Clindamycin (n = 24) | 16 days | 64% | 0.002* | OR = 7, 95% CI 2.1–26.5 | ||
| Cefazolin (n = 16) | N/A | 44% | 0.73 | OR = 1.2, 95% CI 0.3–4.8 | ||
| Other (n = 6)e | N/A | 50% | 0.13 | OR = 4.6, 95% CI 0.6–36.1 | ||
| Saunders et al. (2017) [5] | OBS (n = 72) | Cefazolin–metronidazole (n = 50) | 7 days (n = 72) | 32% | 0.02* | OR = 1.00 |
| Clindamycin (n = 9) | 100% | |||||
| Other (n = 13)c | 23.1% | OR = 14.4, 95% CI 1.52–135.9 | ||||
| Haidar et al. (2018) [8] | SR (n = 697) | Ampicillin–sulbactam (n = 482) | < 1 day | Overall SSI rate 6.6–22.1% | < 0.001* | RR = 2.85, 95% CI 1.95–4.17 |
| Clindamycin (n = 169) | > 1 day | |||||
| Other (n = 46)d | ||||||
| Veve et al. (2018) [23] | OBS (n = 1307) | No gram-negative coveragef (n = 171) | < 6 days vs > 6 days | Overall SSI rate 15% | < 0.001* | OR = 2.2, 95% CI 1.5–3.3 |
| Enteric gram-negative coveragef (n = 522) | 0.42 | OR = 0.58, 95% CI 0.42–0.80 | ||||
| Antipseudomonal gram-negativef (n = 311) |
RCT randomized controlled trial, OBS observational study, SR systematic review, n number of participants, CI confidence interval, OR odds ratio, N/A not applicable
*p < 0.05 is considered statistically significant
aStandard antibiotics include cefazolin–metronidazole, cefuroxime–metronidazole, and amoxicillin–clavulanate. The alternative group includes clindamycin, clindamycin–gentamicine, and clindamycin–metronidazole
bStandard antibiotics include ampicillin–sulbactam, cefazolin–metronidazole, and cefuroxime–metronidazole
cOther antibiotics include cefazolin, levofloxacin, vancomycin, or a combination
dOther antibiotics include levofloxacin, vancomycin, cefazolin, ampicillin–sulbactam, cefepime, piperacillin–tazobactam, ciprofloxacin, or combinations
eOther antibiotics include vancomycin, piperacillin–tazobactam, daptomycin, or combinations
fAntibiotics without gram-negative coverage include clindamycin, metronidazole, linezolid, and vancomycin. Antibiotics with enteric gram-negative coverage include cefazolin, cephalexin, ceftriaxone, amoxicillin–clavulanate, ampicillin–sulbactam, cefoxitin, cefotetan, ertapenem, moxifloxacin, doxycycline, trimethoprim–sulfamethoxazole. Antibiotics with enteric gram-negative and antipseudomonal coverage include aztreonam, gentamicin, cefepime, ciprofloxacin, levofloxacin, imipenem–cilastatin, meropenem, and piperacillin–tazobactam