A Meta-Analysis of Randomized, Controlled Trials Assessing the Prophylactic Use of Ceftriaxone. A Study of Wound, Chest, and Urinary Infections

• Published in: World journal of surgery Vol. 33; no. 12; pp. 2538 - 2550
• Main Authors: Woodfield, J. C., Beshay, N., van Rij, A. M.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-12-2009; Springer‐Verlag; Springer
• Subjects: Abdominal Surgery; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis; Bacterial diseases; Bacterial diseases of the urinary system; Biological and medical sciences; Cardiac Surgery; Ceftriaxone; Ceftriaxone - administration & dosage; General aspects; General Surgery; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Medicine; Medicine & Public Health; Minimal Inhibitory Concentration; Pneumonia; Pneumonia - prevention & control; Prevention and actions; Prophylactic Antibiotic; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomized Controlled Trials as Topic; Surgery; Surgical Wound Infection - prevention & control; Thoracic Surgery; Urinary Tract Infection; Urinary Tract Infections - prevention & control; Vascular Surgery; Urinary Tract Infection; Pneumonia; Ceftriaxone; Minimal Inhibitory Concentration; Prophylactic Antibiotic; Evaluation; Urinary system disease; β-Lactams; Use; Thorax; Urinary tract disease; Wound; Randomized controlled trial; Metaanalysis; Medicine; Prevention; Cephalosporin derivatives; Antibiotic; Urinary tract infection; Randomization; Treatment; Surgery; Clinical trial; Antibacterial agent
• DOI: 10.1007/s00268-009-0158-4
• EISSN: 1432-2323
• ISSN: 0364-2313

Background
Ceftriaxone is an effective prophylactic antibiotic. However, there is no consensus about whether ceftriaxone should be used as a first-line antibiotic for the prevention of incisional surgical site infection (SSI). Its role in preventing urinary tract infection (UTI) and pneumonia also is controversial.
Methods
A meta-analysis of randomized, controlled trials assessing the prophylactic use of ceftriaxone between 1983 and 2005 was performed. Medline, Embase, and Cochrane registers were reviewed. Additional references, review papers, and proceedings from meetings were searched. The Jadad score was used to assess study quality. A meta-analysis with sensitivity analyses was performed for SSI, UTI, and pneumonia.
Results
Of 231 reviewed papers, 90 were included. Ceftriaxone prophylaxis was superior to other antibiotics in each category. Sixty-one studies assessed the prevention of SSI (odds ratio (OR), 0.68; 95% confidence interval (CI), 0.53–0.7,
p
 < 0.001; Cochran’s Q statistic,
p
 = 0.93). The difference was greatest for abdominal surgery. There was no difference for cardiac surgery. Thirty-five studies assessed the prevention of UTI (OR 0.53; 95% CI 0.43–0.63,
p
 = 0; Cochran’s Q statistic,
p
 = 0.97). The difference was greatest in obstetric and gynecological and colorectal surgery. Thirty-seven studies assessed the prevention of pneumonia (OR 0.66; 95% CI 0.54–0.81,
p
 = 0; Cochran’s Q statistic,
p
 = 0.65). The difference was greatest in upper abdominal surgery.
Conclusions
The meta-analysis confirms that prophylactic ceftriaxone is more effective than most other prophylactic antibiotics. This reduces SSI, UTI, and pneumonia in procedures where there is an increased risk of these infections. In such procedures, the data support using ceftriaxone as a first-line prophylactic antibiotic.