CAJ | 학술논문

目的:分析预防性抗生素能否减少术前为清洁尿、行经直肠前列腺活检术(TPB)患者的术后感染性并发症.方法:制定原始文献的纳入标准、排除标准及检索策略, 在MEDLINE(1979.01-2007.12)、EMBASE(1988.01-2007.12)、Cochrane Collaboration Reviews (1993.01-2007.12)、中国生物医学期刊文献数据库(CMCC,1979-2007.12)、CNKI数字图书馆(1979.01-2007.12)进行相关的随机对照试验(RCT)的检索,采用Rev Man 4.2软件进行Meta分析.结果:共检索到相关随机对照试验68篇,排除56篇,符合纳入标准12篇进入Meta分析.结果显示,术前清洁尿的患者,预防性抗生素能显著降低TPB术后1周内菌尿和术后中度发热的发生率, 但不能减少菌血症的发生率,其RR值及其95%CI分别为0.32(0.23～0.46),0.37(0.17～0.77) 和0.96(0.61～1.50);各疗程抗生素均能明显减少TPB术后菌尿的发生率,差别无统计学意义;喹诺酮、喹诺酮联合硝基咪唑以及TMP+SMZ均能明显降低TPB术后发生菌尿的危险.结论:术前为清洁尿的患者,预防性应用抗生素能减少TPB术后菌尿和发热的发生率,但不能降低菌血症的发生率;喹诺酮、喹诺酮联合硝基咪唑均能明显降低TPB术后发生菌尿的危险,各疗程抗生素均能明显减少TPB术后菌尿的发生率.
목적:분석예방성항생소능부감소술전위청길뇨、행경직장전렬선활검술(TPB)환자적술후감염성병발증.방법:제정원시문헌적납입표준、배제표준급검색책략, 재MEDLINE(1979.01-2007.12)、EMBASE(1988.01-2007.12)、Cochrane Collaboration Reviews (1993.01-2007.12)、중국생물의학기간문헌수거고(CMCC,1979-2007.12)、CNKI수자도서관(1979.01-2007.12)진행상관적수궤대조시험(RCT)적검색,채용Rev Man 4.2연건진행Meta분석.결과:공검색도상관수궤대조시험68편,배제56편,부합납입표준12편진입Meta분석.결과현시,술전청길뇨적환자,예방성항생소능현저강저TPB술후1주내균뇨화술후중도발열적발생솔, 단불능감소균혈증적발생솔,기RR치급기95%CI분별위0.32(0.23～0.46),0.37(0.17～0.77) 화0.96(0.61～1.50);각료정항생소균능명현감소TPB술후균뇨적발생솔,차별무통계학의의;규낙동、규낙동연합초기미서이급TMP+SMZ균능명현강저TPB술후발생균뇨적위험.결론:술전위청길뇨적환자,예방성응용항생소능감소TPB술후균뇨화발열적발생솔,단불능강저균혈증적발생솔;규낙동、규낙동연합초기미서균능명현강저TPB술후발생균뇨적위험,각료정항생소균능명현감소TPB술후균뇨적발생솔.
ObjectiveTo determine whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transrectal prostatic biopsy (TPB) who had sterile preoperative urine.MethodsMEDLINE, EMBASE, Cochrane Collaboration Reviews, Chinese Medical Current Contents (CMCC), and National Knowledge Infrastructure (CNKI) were searched for rando-mized controlled trials that compared the effect of antibiotic prophylaxis with placebo or active controls for men undergoing TPB with preoperative sterile urine. Two reviewers independently extracted the data of patient characteristics and outcomes based on a prospectively developed protocol.ResultsA total of 12 trials (3 placebo controlled, 3 non-treatment controlled, and 6 activly controlled) involving 1 987 patients, met the inclusion criteria. Prophylactic antibiotic use in patients at low risk undergoing TPB significantly decreased bacteriuria and middle degree fever incidence, but could not decrease the incidence of bacteremia. The relative risk for post-TPB bacteriuria, middle degree fever, and bacteremia were 0.32 (95% CI 0.23 to 0.46), 0.37 (95% CI 0.17 to 0.77), and 0.96 (95% CI 0.61 to 1.50), respectively. Effective antibiotic classes included quinolone, co-quinolone and nitroimidazole, and co-trimethoprim and sulfamethoxazole. Treatment protocols of any duration were effective.ConclusionAntibiotic prophylaxis obviously decreases the incidence of bacteriuria and middle degree fever but not bacteremia in men with preoperative sterile urine undergoing TPB. A significant decrease in bacteriuria incidence can be achieved with a range of antibiotic agents, including quinolones and co-quinolone and nitroimidazole. Treatment protocols of any duration are effective with no heterogeneity.