Is Antibiotic Prophylaxis in Surgery a Generally Effective Intervention? Testing a Generic Hypothesis Over a Set of Meta-Analyses

Department of Public Health and Epidemiology, School of Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Annals of surgery (Impact Factor: 8.33). 05/2009; 249(4):551-6. DOI: 10.1097/SLA.0b013e318199f202
Source: PubMed


While the main focus of a meta-analysis is often to assess the effectiveness of a particular intervention in managing or curing a specific condition, there exists a substantial amount of information within published systematic reviews that could be used to assess the validity of a generic hypothesis about the effectiveness of an intervention across a range of different but related conditions.
To systematically search for and then collate the results of meta-analyses for the effectiveness of antibiotic prophylaxis in preventing postoperative wound infection across various types of surgery in order to assess generic hypotheses about the effectiveness of this intervention in surgery as a whole. With the relative risk of wound infection used as the measure of clinical effectiveness, the hypotheses to be assessed were first that antibiotic prophylaxis would be an effective intervention for preventing wound infection over a broad range of different surgical procedures, and second that there would be a substantial difference in the effectiveness of antibiotic prophylaxis between "clean" and "contaminated" surgical procedures.
Medline and the Cochrane Database of Systematic Reviews.
Eligible meta-analyses were meta-analyses published between 1990 and 2006 of randomized controlled trials that looked at the effectiveness of prophylactic antibiotics versus no antibiotic or placebo in preventing postoperative wound infections.
Independent data extraction by multiple observers.
The first hypothesis was strongly supported by the data as evidenced by the fact that the estimates of the relative risk of infection for the 23 types of surgery that were included in the study were all less than 1. However, there was no real evidence supporting the second hypothesis that the relative risk of wound infection would substantially vary over different levels of surgery cleanliness.
: As well as antibiotic prophylaxis being a generally effective intervention for preventing postoperative wound infection, the level of this effectiveness would appear to be reasonably independent of what type of surgery is being considered. Therefore, the general prevailing attitude that antibiotic prophylaxis should be assumed to be ineffective unless its effectiveness has been experimentally proven beyond doubt for the specific type of surgery being considered, perhaps should be revised. In particular, perhaps a sensible philosophy would be to assume that antibiotic prophylaxis is effective in reducing the risk of wound infection for all types of surgery, even ones where no clinical trial data exists and make exceptions to this rule if, for certain types of surgery, it can be proved to the contrary.

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    • "According to Howe and Boothe (2006), each type of surgical procedure and each body system encountered has its own unique risks and potential pathogens that could result in Surgical Site Infections (SSIs). Therefore, antibiotic usage following surgery for prevention of increased morbidity and expenses associated with surgical infection is a well-accepted part of clinical practice (Holmberg, 1978; Ludwig et al., 1993; Furukawa et al., 2004; Bowater et al., 2009); whereas, the bacterial populations of the control animals in this study were not reduced after partial gastrectomy, while also, there were no recorded postoperative infections in both the experimental animals and the control animals. Moreover, the study of Kang et al. (2009) also reported that there was no significant difference in the incidence of postoperative wound infections between patients who had received postoperative prophylactic antibiotic administration and those who had not. "
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    ABSTRACT: Prolonged post-surgical antibiotic administration may be of less advantage in prevention of post-surgical infections. This study therefore, aimed at investigating the prolonged effect of empiric administration of three most-prescribed antibiotics (amoxicillin, cefotaxime and oxytetracycline) by veterinary practices in Southwest Nigeria on intestinal bacterial population of dogs undergoing partial, non-laparoscopic gastrectomy. Using conventional quantitative and qualitative microbial culture procedures, the total bacterial populations were mostly too numerous to count (TNTC) before gastrectomy but log103-105 cfu/mL after, while control were log 105-107 cfu/mL after gastrectomy. On general-purpose, special, differential and selective culture media, total bacterial counts with increasing post-operative days were-amoxicillin (11 mg/kg) day 4: log 105-10-9/TNTC cfu/mL vs. day 8: log 103-105 cfu/mL; cefotaxime (25 mg/kg) day 4: log 103-108/TNTC/cfu/mL vs. day 8: log 102-105 cfu/mL; oxytetracycline (10 mg/kg) day 4: log 104-109 TNTC cfu/mL vs. day 8: log 102-106 cfu/mL. Total bacterial counts of control animals were-day 4: log 105-108/TNTC cfu/mL vs. day 8: log 105-109. Total qualitative populations of predominant, easily-recoverable aerobic and anaerobic rectal canine bacteria, Staphylococcus and lactobacilli were significantly less after gastrectomy but reductions in post-operative bacterial populations were mostly more pronounced among the anaerobes (lactobacilli and Clostridium perfringens). No post-operative infection was recorded among all the experimental animals, including the control animals. In conclusion, this study confirmed significant reduction effect of prolonged empiric antibiotic administration on rectal (intestinal) bacterial populations of experimental local dogs that had partial, non-laparoscopic gastrectomy.
    Full-text · Article · Jan 2015 · Journal of Animal and Veterinary Advances
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    • "Antimicrobial prophylaxis is only one relatively minor effort among numerous preventive measures against microbial infections, and although it is not a substitute for good surgical techniques, the efficacy and impact of pre-operative and post-operative antimicrobial prophylaxis has been demonstrated to be significant (Stinner et al., 1998; Bowater et al., 2009) but timing of antibiotic administration is critical for efficacy (Wilcke, 1990; Dunning, 2003). In certain gastrointestinal procedures, oral and intravenous administration of antimicrobial agents with activity against Gram-negative and anaerobic bacteria is warranted. "
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    ABSTRACT: Reliable data that can serve as platform for policy formulation on the use of an-timicrobial drugs are compulsory for every country. But baseline data to judge effects of long-term post-operative antibiotic administration in clinical and surgical canine health conditions are currently lacking in Nigeria. This study aimed at providing vital baseline antibiotic profiles of canine bacteria of veterinary and public health importance. Phenotypic antibiotic susceptibility and resistance profiles of some easily recoverable Gram-negative bacterial species of canine origin were determined towards the most commonly prescribed and administered antibiotics in veterinary practices, using agar disk-and modified agar well-diffusion methods. Overall resistance of the bacteria against antibiotics (discs) were-tetracycline (25.0-57.1%), cotrimoxazole (80.0-100%), nitrofurantoin (20.0-100%), nalidixic acid (0.91-60.0%), gentamicin (18.2-70.0%), ofloxacillin (20.0-42.9%) and augmentin / amoxicillin (100%), except among Klebsiella pneumoniae and Proteus mirabilis (60.0-100), with percentage multiple antibiotic resistance (%MAR) of 25.0-100%. Overall percentage resistance rates towards antibiotic drugs were-amoxicillin (9.1-100%); oritaxim / oxytetracycline (20.0-100%) and nitaxim (30.0-100%), with %MAR mostly between 50.0 and 100%. Twenty eight antibiotic resistance profiles were exhibited against antibiotic (discs), commonest profiles being – augmentin-amoxicillin-cotrimoxazole; augmentin-tetracycline-amoxicillin-cotrimoxazole-ni-trofurantoin-nalidixic acid-gentamicin-ofloxacillin; augmentin-tetracycline-amox-icillin-cotrimoxazole and augmentin-amoxicillin-cotrimoxazole-nitrofurantoin. Twelve antibiotic resistance profiles were exhibited against the antibiotic drugs, with most-resisted / commonest profile being – oritaxim-nitaxim. These were also the most-resisted nitaxim (47.3%) and oritaxim (52.7%) antibiotic drugs. Only
    Full-text · Article · Dec 2014
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    • "Les antibiotiques et antimicrobiens vétérinaires sont généralement utilisés en élevage à des buts, thérapeutique, prophylactique, métaphylactique et comme additifs alimentaires ou promoteur de croissance (Dibner et al., 2005 ; Guardabassi et al., 2008 ; Bowater et al., 2009 ; Nickell et White, 2010). En élevage bovin, une gamme très variée d'antibiotiques est utilisée par les éleveurs pour lutter contre diverses maladies et améliorer le rendement de leurs productions (Thomson et al., 2008 ; Regula et al., 2009 ; Pardon et al., 2012). "
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    ABSTRACT: Objectif: Une étude a été réalisée dans le but d’évaluer la présence de résidus d’antibiotiques dans le lait cru des vaches élevées dans les exploitations bovines sédentaires installées dans neuf communes du Département du Zou et une commune du Département des Collines au Bénin.Méthodologie et résultats: A cet effet, cent quatre vingt (180) échantillons de lait cru ont été collectés à raison de deux prélèvements par élevage réalisés à 15 jours d’intervalle. Tous les échantillons ont été analysés à l’aide du kit Delvotest T (DSM Food Specialities) de détection rapide de résidus d’antibiotiques dans le lait. Sur les 2 prélèvements, seuls les échantillons de lait du premier prélèvement des élevages installés à Bohicon et Ouinhi n’étaient pas positifs aux résidus d’antibiotiques. Le taux des échantillons de lait positifs aux résidus d’antibiotiques par commune ont varié de 0 à 100 % au premier prélèvement et de 33 à 83 % au deuxième prélèvement.Conclusion et application : L’étude révèle la présence effective de résidus d’antibiotiques dans le lait cru de vache en provenance d’une proportion très variée de fermes d’élevage, caractérisant ainsi les communes étudiées comme des zones d’élevage bovin à risque faible, moyen ou élevé. L’utilisation des antibiotiques doit se faire par les professionnels de la santé animale ou sous leur responsabilité.Mots clés : résidus d’antibiotique, lait cru, bovin, risque, Bénin
    Full-text · Article · Sep 2014
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