Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

Juliana Arruda de Matos; Amanda da Silva Gomes; Carla Ormundo G Ximenes Lima; Carolina Arana Stanis Schmaltz; Cristiane Rocha de Oliveira; Grasiela Martins da Silva; Júlia Herkenhoff Carijó; Marilena Aguiar Lopes; Quenia Cristina Dias Morais; Pedro Emmanuel Alvarenga Americano do Brasil

doi:10.1016/j.bjid.2022.102705

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

Braz J Infect Dis. 2022 Nov-Dec;26(6):102705. doi: 10.1016/j.bjid.2022.102705. Epub 2022 Oct 11.

Affiliations

¹ Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Rio de Janeiro, RJ, Brazil. Electronic address: juliana.matos@ini.fiocruz.br.
² Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil.
³ Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brazil.
⁴ Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Rio de Janeiro, RJ, Brazil.

Abstract

Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI.

Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software.

Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate).

Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

Keywords: Drug resistance, multiple; Gram-negative bacterial infections; Infection control; Surgical wound infection; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Aminoglycosides / therapeutic use
Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Drug Resistance, Multiple, Bacterial
Gram-Negative Bacteria
Gram-Negative Bacterial Infections* / drug therapy
Gram-Negative Bacterial Infections* / prevention & control
Humans
Prospective Studies
Retrospective Studies
Surgical Wound Infection* / prevention & control

Substances

Anti-Bacterial Agents
Aminoglycosides