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

• Published in: The Brazilian journal of infectious diseases 2022-11, Vol.26 (6), p.102705-102705, Article 102705
• Main Authors: Matos, Juliana Arruda de, Gomes, Amanda da Silva, Lima, Carla Ormundo G. Ximenes, Schmaltz, Carolina Arana Stanis, Oliveira, Cristiane Rocha de, Silva, Grasiela Martins da, Carijó, Júlia Herkenhoff, Lopes, Marilena Aguiar, Morais, Quenia Cristina Dias, Brasil, Pedro Emmanuel Alvarenga Americano do
• Format: Article
• Language: English
• Subjects: Adult; Aminoglycosides - therapeutic use; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Drug resistance, multiple; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Gram-negative bacterial infections; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - prevention & control; Humans; Infection control; INFECTIOUS DISEASES; Original; Prevention; Prospective Studies; Retrospective Studies; Surgery, Experimental; Surgical research; Surgical wound infection; Surgical Wound Infection - prevention & control; Surgical wound infections; Systematic review
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2022.102705

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. 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. 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). 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.