Infection Control & Hospital Epidemiology
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Fig. 4. Forest plot of included studies for colorectal surgery with pooled proportion of wound infection with use of currently recommended prophylactic antibiotics (cefoxitin, cefotetan, or cefazolin plus metronizadole).
For TRBP, there were 2,570 participants in the 15 RCTs. Cipro- floxacin was the prophylactic antibiotic in 9 RCTs and levo- floxacin was the prophylactic antibiotic in 2 RCTs. In 1 RCT, patients received either ciprofloxacin or levofloxacin. Ofloxacin, perfloxacin, and prulifloxacin were used as prophylactic anti- biotics in 1 RCT each. The pooled proportion of infections (UTIs and sepsis) following TRPB using the recommended prophylactic antibiotics (fluoroquinolones) was 1.2% (95% CI=0.4–2.3; τ2=0.013) (Fig. 5). The postoperative infection trends over time following 4 procedures are presented in Fig 6. Because time was modeled as a continuous variable, the odds ratios presented here represent the variation in each calendar year after adjusting for country of the study. No statistically significant association was observed between the probability of infection and the year of study pub- lication for appendectomy (adjusted odds ratio (aOR), 1.03; 95%
CI, 0.92–1.16; P=.57), for cesarean section (aOR, 1.006; 95% CI, 0.96–1.05; P=.80), or for TRPB (aOR, 0.95; 95% CI, 0.77–1.19; P=.67) (Supplementary Tables 2–7). However, a significant increase was observed in the proportion of infections following colorectal surgery (aOR, 1.05; 95% CI, 1.03–1.07; P < .001). For colorectal surgery, the infection trends remained sig-
nificant (aOR, 1.05; 95% CI, 1.02–1.07; P<.001) even after adjusting for the antibiotic (cefotetan, cefoxitin, or cefazolin plus metronidazole) and the type of surgery (elective, emergency, both, or not mentioned), even after excluding the most recent study,45 conducted between 2002 and 2005, which reported a high SSI rate with cefotetan (Supplementary Tables 4–6). In a subanalysis of 22 RCTs37,39,42,43,45,47–49,52,53,55,56,61,62,65,67–70,73,74 in which prophy- lactic antibiotics were given within 60 minutes prior to incision or at the time of induction of anesthesia, and patients were followed at least for 4 weeks, and infections involving surgical incision,
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