预防性使用抗生素对术后颅内感染有效性的荟萃分析
Title： Efficacy of prophylactic antibiotics against meningitis after craniotomy: ameta－analysis.
Author： Barker FG 2nd.
Resource: Neurosurgery. 2007 May;60(5):887-94; discussion 887-94.
Abstract： OBJECTIVE: Although prophylactic antibiotics have been shown by randomized clinical trials (RCTs) to help prevent deep infection after craniotomies, recent
reports have suggested that antibiotics are not effective in preventing
postcraniotomy meningitis. METHODS: Data on meningitis as an end point from RCTs
on prophylactic antibiotics for craniotomies were pooled in a random-effects
meta-analysis. RESULTS: Six prospective randomized trials or trial subgroups
enrolling 1729 patients or operations were identified. Antibiotics reduced
postoperative infection rates in five of the six RCTs; no trial individually
showed a statistically significant benefit from antibiotics. The pooled odds
ratio for meningitis with antibiotic treatment in the six RCTs was 0.43 (95%
confidence interval, 0.20-0.92; P = 0.03). Subgroup analyses showed no
detectable difference in antibiotic efficacy if antibiotics, with or without
gram- negative coverage, were used or if the trial was single or double blinded.
A sensitivity analysis showed modest dependence of the results of the analysis
on the specific definition of postoperative meningitis used in interpreting
trial results. CONCLUSION: Prophylactic antibiotics administered before
craniotomy reduce rates of postoperative meningitis by approximately one-half, a
statistically and clinically significant benefit.
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