Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients.Chan, S., et al.
Cochrane Database of Systematic Reviews 2020; 8: CD013209.
The aim of this study was to evaluate the beneficial and harmful effects of prophylactic antimicrobial agents in the prevention of surgical site infections among solid organ transplant patients.
The Cochrane Kidney and Transplant Register of Studies, which contained studies identified from Cochrane CENTRAL, MEDLINE, EMBASE, the International Clinical Trials Register (ICTRP) Search Portal, conference proceedings and ClinicalTrials.gov, was searched up to 21st April 2020. Two independent authors performed study selection and data extraction. The risk of bias was assessed using the Cochrane risk of bias tool.
8 studies were included in the review.
The primary outcome was surgical site infections. The secondary outcomes included graft loss, any-cause death, antimicrobial resistance, graft health, incidence of graft rejection, wound dehiscence/wound exploration, cardiovascular disease, adverse reactions to antibiotics, duration of hospitalization, cancer, life participation, haematological and biochemical parameters, cost of intervention and side-effects, other infections (e.g. pneumonia, urinary tract infections (UTI), bacteraemia), and overall hospitalisation cost.
The thorough Cochrane systematic review investigates the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients. The comprehensive search identified eight randomised controlled trials. Risk of bias was unclear or high for most of the items of the Cochrane risk of bias tool. Only the risk of attrition bias and other bias was considered low for most studies. The GRADE tool was used to assess the certainty of the evidence. For the primary outcome, i.e. surgical site infections, the relative risk showed a positive effect of antibiotics to prevent post-surgical site infections, however the certainty of the evidence was considered very low. The certainty of the evidence was also assessed as very low when comparing extended versus short duration antibiotics. The authors conclude that the level of evidence was limited by small study samples, short follow-up duration and limited methodological quality of the included studies and conclude that the benefits of prophylactic antimicrobial agents for the prevention of surgical site infections remain uncertain.