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Revista Panamericana de Salud Pública/Pan American Journal of Public Health Supplementary material to: Brocard E, Reveiz L, Regnaux JP, Abdala V, Ramon Pardo P, Del Rio Bueno A. Prophylaxis for Surgical Procedures: a scoping review. Rev Panam Salud Publica. 2021;45:e62. https://doi.org/10.26633/RPSP.2021.62 This material is part of the original submission and has been submitted to arbitration. It is published without editing as it has been sent by the authors

APPENDIX 1: Search Strategy on PubMed identified

(("Antibiotic Prophylaxis"[MJ] OR ("Antibiotic Prophylaxis"[TI] OR "Antibiotic Premedication"[TI] OR "Antibiotic Premedications"[TI]) OR (("Anti-Infective Agents"[MJ] OR "Anti-Bacterial Agents"[MJ] OR antibiotic* OR alamethicin* OR amdinocillin* OR (amdinocillin pivoxil*) OR * OR * OR ("amoxicillin-potassium" clavulanate) OR amphotericin* OR * OR anisomycin* OR antimycin* OR aurodox* OR * OR * OR * OR * OR bacteriocin* OR bambermycin* OR (bongkrekic acid*) OR brefeldin* OR (butirosin sulfate*) OR calcimycin* OR candicidin* OR capreomycin* OR * OR carfecillin* OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR * OR cephacetrile* OR cephalexin* OR cephaloglycin* OR * OR * OR cephalothin* OR * OR cephapirin* OR cephradine* OR * OR * OR citrinin* OR * OR (*) OR * OR * OR * OR cyclacillin* OR dactinomycin* OR * OR * OR * OR * OR ( sulfate*) OR diketopiperazine* OR distamycin* OR * OR echinomycin* OR edeine* OR enviomycin* OR * OR filipin* OR floxacillin* OR fluoroquinolone* OR * OR framycetin* OR (*) OR * OR * OR hygromycin* OR * OR * OR kanamycin* OR * OR lactam* OR lasalocid* OR leucomycin* OR * OR lincosamide* OR lucensomycin* OR * OR mepartricin* OR methacycline* OR * OR * OR mikamycin* OR * OR * OR moxalactam* OR * OR mycobacillin* OR * OR natamycin* OR nebramycin* OR * OR * OR netropsin* OR nigericin* OR nisin* OR norfloxacin* OR novobiocin* OR nystatin* OR ofloxacin* OR * OR oligomycin* OR * OR * OR * OR (penicillanic acid*) OR (penicillic acid*) OR * OR * OR * OR b* OR polymyxin* OR * OR prodigiosin* OR * OR rifabutin* OR * OR ristocetin* OR * OR roxarsone* OR * OR rutamycin* OR sirolimu* OR * OR * OR * OR ** OR * OR streptovaricin* OR * OR * OR * OR sulfamethoxypyridazine* OR * OR * OR * OR * OR * OR thiostrepton* OR * OR * OR * OR tunicamycin* OR * OR * OR * OR valinomycin* OR * OR vernamycin* OR viomycin* OR * OR "beta-lactams") AND (Prophylaxis OR prevention OR premedication OR prophylactic*)) AND (surgery[CT] OR "Surgical Procedures, Operative" OR "Ghost Surgery" OR "Operative Procedure" OR "Operative Procedures" OR "Operative Surgical Procedure" OR "Operative Surgical Procedures" OR "Procedure, Operative" OR "Procedure, Operative Surgical" OR "Procedures, Operative" OR "Procedures, Operative Surgical" OR "Surgery, Ghost" OR "Surgical Procedure, Operative" OR E04*[MH] OR "non-surgical"[TI] OR "non surgical"[TI] OR "Non-surgical procedure" OR "non-operative procedure" OR "Non-surgical procedures" OR "non-operative procedures")) NOT ("Periodontal Diseases"[MH] OR "Surgery, oral"[MH] OR dentistry[MH] OR "Surgery, Oral" OR Exodontics OR "Maxillofacial Surgery" OR "Oral Surgery" OR "Surgery, Maxillofacial APPENDIX 2: Quality assessment scores of the included systematic review, from lowest to highest.

Study ID AMSTAR 2 score Carney et al. 2018 Critically Low quality score

Blood et al. 2017 Critically Low quality score

Ghobrial et al. 2015 Critically Low quality score

Fernicola et al. 2020 Critically Low quality score

Cussans et al. 2016 Critically Low quality score

La Regina et al. 2020 Critically Low quality score

Foster et al. 2018 Critically Low quality score

Soteropulos et al. 2019 Critically Low quality score

Abraham et al. 2017 Critically Low quality score

Vijendren et al. 2019 Critically Low quality score

Hussain et al. 2018 Critically Low quality score Al-Abduljabbar et al. 2017 Critically Low quality score

Jaworski et al. 2019 Critically Low quality score

Gouvêa et al. 2015 Critically Low quality score

Mocanu et al. 2019 Critically Low quality score

Mayne et al. 2018 Low quality score

King et al. 2018 Low quality score

Shao et al. 2019 Low quality score

Tanner et al. 2015 Low quality score

Song et al. 2016 Low quality score

Vander Poorten et al. 2020 Low quality score

Moldovan et al. 2019 Low quality score

Huang et al. 2016 Low quality score

Xu et al. 2016 Low quality score

Di Spiezio et al. 2016 Low quality score

Gandra et al. 2018 Low quality score

Weiss et al. 2019 Low quality score Tan et al. 2020 Low quality score

Nguyen et al. 2016 Low quality score

Hajibandeh et al. 2019 Moderate quality score

Erdas et al. 2016 Moderate quality score

Thornley et al. 2015 Moderate quality score

Yao et al. 2018 Moderate quality score

Sanders et al. 2019 Moderate quality score

Sadigursky et al. 2019 Moderate quality score

Modha et al. 2018 Moderate quality score

Morgenstern et al. 2018 Moderate quality score

Musters et al. 2015 Moderate quality score

Yang et al. 2016 Moderate quality score

Noreikaite et al. 2018 Moderate quality score

Carey et al. 2015 Moderate quality score

Kim et al. 2018 Moderate quality score

Liang et al. 2016 Moderate quality score

Alrammaal et al. 2019 Moderate quality score

Liu et al. 2019 Moderate quality score

Carter et al. 2017 Moderate quality score

Guo et al. 2019 Moderate quality score

Lynch et al. 2018 Moderate quality score

Loggini et al. 2020 Moderate quality score

Nuyen et al. 2019 Moderate quality score

Kessel et al. 2015 Moderate quality score

Texakalidis et al. 2019 Moderate quality score

Ramos et al. 2016 Moderate quality score de Jonge et al. 2017 Moderate quality score

Purba et al. 2018 Moderate quality score

Baltodano et al. 2019 Moderate quality score

Voigt et al. 2016 High quality score

Sousa et al. 2019 High quality score Siddiqi et al. 2019 High quality score

Zhang et al. 2019 High quality score

Peng et al. 2019 High quality score

Joaquim et al. 2019 High quality score

Zeng et al. 2019 High quality score

Brand et al. 2019 High quality score

Matsui et al. 2018 High quality score

Boonchan et al. 2017 High quality score

Almeida et al. 2015 High quality score

Bollig et al. 2018 High quality score

Nabhan et al. 2016 High quality score

Gallagher et al. 2019 High quality score

Zapata-Copete et al. 2017 High quality score

Ayeleke et al. 2017 High quality score

Pop-Vicas et al. 2019 High quality score

Habib et al. 2019 High quality score

Bowen et al. 2018 High quality score

Gower et al. 2017 High quality score

Bokhari et al. 2019 High quality score

Alotaibi et al. 2016 High quality score

Liu et al. 2017 High quality score

Guo et al. 2019 High quality score

Srisung et al. 2017 High quality score

Liu et al. 2018 High quality score

López-Cano et al. 2019 High quality score

APPENDIX 3: Detailed summary of systematic reviews characteristics (study design, surgical procedure, reported) and their key findings.

Study ID Study Design Surgical Procedure Antibiotics reported Key findings for Primary Outcomes Thornley P, Evaniew N, Riediger M, Winemaker M, Bhandari M, Ghert M. Postoperative Systematic review and Meta-analysis Total joint arthroplasty Nafcillin or cefazolin, teicoplanin, cefuroxime SSI incidence higher (3.1%) of the 2055 patients given postoperative antibiotic prophylaxis and in 45 (2.3%) of the 1981 in the no-treatment group. Non statistically significant findings on antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta- postoperative antibiotic prophylaxis for reduction of SSI rates (risk difference 0.01, 95% CI 0.00 to 0.02; heterogeneity I2 = 26%). analysis of randomized controlled trials. CMAJ Open. 2015;3(3): E338-E343.

Voigt, J., Mosier, M. & Darouiche, R. Antibiotics and for preventing infection Systematic review and Meta-analysis Total joint arthroplasty 1st vs. 2nd generation cephalosporin, mupirocin Statistically significant findings comparing vancomycin impregnated cement + IV cefazolin to IV cefazolin in revision TKA procedures (P = 0.0129). Non-significant findings on the 1 year in people receiving revision total hip and knee prostheses: a systematic review of outcome of infection when comparing 1st generation vs. 2nd generation in TKA revision (RR = 0.29; 95% CI: 0.01 to 6.95; P = 0.45). Non-significant findings for the comparison randomized controlled trials. BMC Infect Dis 2016; 16, 749. https://doi. mupirocin vs. povidone iodine (PI) on the outcome of infection at 30 days for either revision THA or revision TKA. org/10.1186/s12879-016-2063-4 Mayne AIW, Davies PSE, Simpson JM. Antibiotic treatment of asymptomatic bacteriuria Systematic review Hip and knee arthroplasty Vancomycin, Cefazolin, Cefuroxime, Teicoplanin The 3 included studies do not support the routine antibiotic treatment of asymptomatic bacteriuria in arthroplasty patients. No statistically significant difference in infections rates found in prior to hip and knee arthroplasty; a systematic review of the literature. Surgeon. either of the studies between patients with asymptomatic bacteriuria treated preoperatively with antibiotics compared to non-treated ASB patients undergoing hip and knee arthroplasty. 2018;16(3):176-182. doi:10.1016/j.surge.2017.08.00 Carney J, Heckmann N, Mayer EN, Alluri R, Vangsness C, Hatch G et al. Should antibiotics be Systematic review and Meta-analysis Arthroscopic knee surgery Vancomycin, cefazolin Stastistically significant difference in post-operative septic arthritis (RR 0.53, 95% CI 0.29-0.99, P = 0.05) for patients (excluding those with graft procedure)(0.08%) who received prophylactic administered before arthroscopic knee surgery? A systematic review of the literature. World J antibiotics compared to those who received none (0.15%). Cases were higher for the non-antibioitc group (0.15% vs 0.08%). Sub-group analysis excluding bony procedures found no Orthop. 2018;9(11):262-270. Published 2018 Nov 18. doi: 10.5312/wjo.v9.i11.262 significant difference in infection rates between administration of prophylactic antibiotics and no antibiotics (P > 0.05). Results showed higher post-operative septic arthritis cases (1.74%) for people undergoing cruciate ligament reconstruction who received IV antibioitics alone compared to no infections for those who received IV antibiotics and had a vancomycin soaked graft (RR 0.01, 95%CI: 0.001-0.229, P < 0.01). King J. D., Hamilton D. H., Jacobs C. A. and Duncan S. T. The Hidden Cost of Commercial Systematic review and Meta-analysis Total knee anthroplasty Gentamicin, Cefuroxime, Tobramycin, Erythromycin, Cefazolin, Antibiotic-Loaded Bone Cement did not reduce PJI prevalence compared to Plain Bone Cement (1.1% vs 0.9%; P = .09). Estimated costs per 1000 primary TKAs were: 2 bags of ALBC = Antibiotic-Loaded Bone Cement: A Systematic Review of Clinical Results and Cost Vancomycin $430,000/y, 1 bag of ALBC +1 bag of plain cement = $275,000/y, and 2 bags of plain cement = $120,000/y. Implications Following Total Knee Arthroplasty. J Arthroplasty. 2018;33(12):3789-3792. doi:10.1016/j.arth.2018.08.009. Sousa RJG, Abreu MA, Wouthuyzen-Bakker M, Soriano AV. Is Routine Urinary Screening Systematic review and Meta-analysis Total joint arthroplasty Not stated Preoperative administration of antibiotics to treat Asymptomatic Bacteriuria (ASB) does not influence PJI risk after total joint arthroplasty (OR 0.98, 95% confidence interval = 0.39-2.44). Indicated Prior To Elective Total Joint Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(7):1523-1530. doi:10.1016/j.arth. 2019.03.034 Siddiqi A, Forte SA, Docter S, Bryant D, Sheth NP, Chen AF. Perioperative Antibiotic Systematic review and Meta-analysis Total joint arthroplasty Cefazolin, Fucloxacillin, Erythromycin, Clindamycin, Cefamandole, No difference in effect between single preoperative dose of antibiotic and continued (preoperative plus postoperative) administration (RR 0.96; 95% CI, 0.73-1.26). However, the 95% CI for Prophylaxis in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Cefuroxime, Amoxicillin/netilmicin, Gentamicin, Teicoplanin, the relative risk would include a reduction of approximately 27% in either group. No difference in effect between SAP of ≤24 and >24 hours postoperatively. Surg Am. 2019;101(9):828-842. doi:10.2106/JBJS.18.00990 Fosfomycin, Lincomycin, Cloxacillin, Zhang J, Zhang XY, Jiang FL, Wu Y, Yang B, Liu Z, et al. Antibiotic-impregnated bone cement Systematic review and Meta-analysis Total joint arthroplasty Gentamicin, Cefuroxime, Tobramycin, Erythromycin + Polymyxin, AIBC found to be more effective than systemic antibiotics (cefazolin) in reducing deep infection rates (OR 0.35, 95% CI 0.14-0.89, P = .030), but higher superficial infection rates with AIBC (OR for preventing infection in patients receiving primary total hip and knee arthroplasty: A Cefazolin 1.53, 95% CI = 1.11-2.11, P = .010). Combination of AIBC and systemic antibiotics significantly decreased deep infection rates compared to systemic antibiotics alone, (OR 0.55, 95% CI = 0.41- meta-analysis. Medicine (Baltimore). 2019;98(49):e18068. doi: 0.75, P = .0001) but no difference in superficial infection rates (OR 1.43, 95% CI = 0.81-2.54, P = .220). Both RCTs (OR 0.61, 95% CI = 0.37-0.99, P = .050) and cohort studies (OR 0.49, 95% CI = 10.1097/MD.0000000000018068 0.34-0.70, P = .0001) sub-group analysis found reduced deep infection rates after primary TJA. AIBC decreased deep infection rates in both total hip and knee arthroplasty (OR 0.25, 95% CI = 0.12-0.52, P = .0002 and OR 0.62, 95% CI = 0.45-0.87, P = .005, respectively). Deep infection rates were significantly decreased by Gentamicin-IBC (OR 0.31, 95% CI = 0.20-0.49, P < .00001) but unaffected by Cefuroxime-IBC (OR 0.35, 95% CI = 0.10- 1.20, P = .100). Yao R, Tan T, Tee JW, Street J. Prophylaxis of surgical site infection in adult spine surgery: A Systematic review Spine surgery Intra-wound vancomycin powder, 1st and 3rd generation Grade C evidence supporting intra-wound vancomycin powder to reduce SSI. Grade B evidence showing that single dose of pre- SAP lowers SSI compared to no antibiotics, that perioperative systematic review. J Clin Neurosci. 2018;52:5-25. doi:10.1016/j.jocn. 2018.03.023 Cephalosporins, Clindamycin multidose does not affect SSI rates compared to single preoperative dose for both lumbar spine surgery and lumbar fusion. Grade B evidence showing that when single dose preoperative antibiotics are given, 3+ days of postoperative AP does not affect SSI rates compared to 2 days or less. Grade B evidence showing that SSI rates are not affected by extension of postoperative AP after 24h for duration of drain usage in thoracolumbar spine surgery. Blood AG, Sandoval MF, Burger E, Halverson-Carpenter K. Risk and Protective Factors Systematic review Spine surgery Cefazolin, Vancomycin Protective factors against postoperative SSI include antibiotic prophylaxis. One study showed that inadequate doses of cefazolin (£20mg/kg) led to greater risk of infection (18%) compared to Associated with Surgical Infections among Spine Patients. Surg Infect (Larchmt). evidence-based doses (>20mg/kg) (infection rate 6.2%, OR=3.3, p=0.0002). One study found that multidoses of 1st-cephalosporins (pre and prolonged 5- 7 after surgery) led to higher SSI risk 2017;18(3):234-249. doi:10.1089/sur.2016.183 (0.8%) compared to single dose given preoperatively (0.4%). Tan T, Lee H, Huang MS, Rutges J, Marion T, Mathew J, et al. Prophylactic postoperative Systematic review Spine surgery Not stated The use of postoperative AMP was not found to reduce SSI rate in lumbosacral spine surgery. Prolonged administration of AMP for more than 48 hours postoperatively does not seem to measures to minimize surgical site infections in spine surgery: systematic review and reduce SSI rate in decompression-only nor lumbar spine fusion surgery. Administration of AMP in the presence of a wound drain did not seem to reduce the overall rate of SSI, deep nor evidence summary. Spine J. 2020;20(3):435-447. doi:10.1016 superficial SSI in thoracolumbar fusion performed for degenerative and deformity spine pathologies, and in adolescent idiopathic scoliosis corrective surgery. /j.spinee.2019.09.013 Peng XQ, Sun CG, Fei ZG, Zhou QJ. Risk Factors for Surgical Site Infection After Spinal Systematic review and Meta-analysis Spine surgery Not stated Results of 4 studies showed that no significant association was found between SSI and the use of prophylactic antibiotics (OR 1.43; 95% CI 0.69-2.98). Surgery: A Systematic Review and Meta-Analysis Based on Twenty-Seven Studies. World Neurosurgery. 2019;123:e318-e329. doi: 10.1016/j.wneu. 2018.11.158. Fernandes J, Buzetti M, Walter D, Rolemberg D, Franz O, Eloy R et al. Intraoperative Systematic review and Meta-analysis Spine surgery Intra-wound vancomycin powder The RCTs indicated infection rates of <2% in both groups (vancomycin and no vancomycin group). Results from case-control studies comparing the use and non-use of intraoperative topical vancomycin powder and post-operative infection after spinal surgery: a systematic review vancomycin powder favored vancomycin use to prevent post-operative infection (OR 0.38; 95% CI : 0.28-0.51; z=-6.26; p< 0.0001). and meta-analysis. Rev. Assoc. Med. Bras. 2019; 65(2). doi: https://doi.org/10.1590/1806- 9282.65.2.253. Ghobrial GM, Cadotte DW, Williams K Jr, Fehlings MG, Harrop JS. Complications from the Systematic review Lumbar spinal surgery Intra-wound vancomycin powder Mean SSIs rates were 1.36% in the vancomycin-treated group compared to 7.47% in the non vancomycin-treated one. Overall adverse event rate of the total number of vancomyin- use of intrawound vancomycin in lumbar spinal surgery: a systematic review. Neurosurg treated patients was 0.3%. 23 adverse events were reported: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in Focus. 2015;39(4):E11. doi:10.3171/2015.7.FOCUS15258 supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). Fernicola S, Elsenbeck M, Grimm P, Pisano A, Wagner S. Intrasite Antibiotic Powder for the Systematic review Orthopaedic surgeries (extremities) Vancomycin, Gentamycin, Tobramycin, Eight studies demonstrated a statistically significant decrease in SSIs with the use of intrasite antibiotic powder for people who underwent total joint arthroplasty, upper extremity, foot and Prevention of Surgical Site Infection in Extremity Surgery: A Systematic Review, Journal of ankle, and trauma. the American Academy of Orthopaedic Surgeons, 2020; 28(1): 37-43. doi: 10.5435/JAAOS-D- 18-00475 Sanders FRK, Goslings JC, Mathôt RAA, Schepers T. Target site antibiotic concentrations in Systematic review and Meta-analysis Orthopedic surgery Cefazolin Target site cefazolin concentrations were significantly higher in the hip (acetabulum, femoral head, or proximal femur) than in the knee (distal femur or proximal tibia) with a mean difference orthopedic/trauma extremity surgery: is prophylactic cefazolin adequately dosed? A of 4 µg/g (CI 0.8–7). Bone concentrations ranged from 0.64 µg/g to 36 µg/g when 1g of cefazolin was given, 8.3 µg/g to 40 µg/g in 2 g, 10 µg/g to 88 µg/g in 4 g, and 7.7 µg/g in the study systematic review and meta-analysis. Acta Orthop. 2019;90(2): 97-104. administering 10 mg/kg. Higher bone concentrations were found after 2g doses of cefazolin. However, pooled results did not show a statistical significant difference. doi:10.1080/17453674.2019.157701 Sadigursky D, Sousa MD, Cajaíba YGL, Martins RR, Lobão DMV. Infectious Prophylaxis Systematic review and Meta-analysis Orthopedic surgery Intra-wound vancomycin powder 2.04% of patients in the group who received intra-wound vancomycin powder developed an SSI, compared to 3.75% of patients who were given none. Local use of vancomycin powder had with Intrawound Vancomycin Powder in Orthopedic Surgeries: Systematic Review with an statistically significant protective effect against SSI in cases of spine surgery (RR 0.59; 95%CI 0.35-0.98). Meta-Analysis. Rev Bras Ortop (Sao Paulo). 2019;54(6): 617-626. doi:10.1016/j.rbo.2017.12.003 Modha MRK, Morriss-Roberts C, Smither M, Larholt J, Reilly I. Antibiotic prophylaxis in foot Systematic review Foot and Ankle surgery Second and third generation Cephalosporin’s, Clindamycin and the Results of SSI rates found ranged from 0 to 9.4% of overall postoperative infections after foot and ankle surgery. A multicentre prospective cohort study of 4238 patients showed that without and ankle surgery: a systematic review of the literature. J Foot Ankle Res. Fluoroquinolone group antibiotic prophylaxis, the infection rate was 2.6% (1.5% higher than the group receiving chemoprophylaxis). A separate cohort which received both pre-& postoperative antibiotics who 2018;11:61. Published 2018 Nov 15. doi:10.1186/s13047-018-0303-0 demonstrated an SSI rate of 2.1%. Shao J, Zhang H, Yin B, Li J, Zhu Y, Zhang Y. Risk factors for surgical site infection following Systematic review and Meta-analysis Open reduction and internal fixation of ankle fractures. Not stated SSI incidence found was 7.19%. The significant increased risk factors with SSI after open reduction and internal fixation of ankle fractures (P < 0.05) were: body mass index (both continuous operative treatment of ankle fractures: A systematic review and meta- analysis. Int J Surg. and dichotomous variables); diabetes; alcohol; open fracture; subluxation/dislocation; incision cleanness grade 2-4; high-energy mechanism; chronic heart disease; history of allergy; and use 2018;56:124-132. doi:10.1016/j.ijsu.2018.06.018 of antibiotic prophylaxis. Morgenstern M, Vallejo A, McNally MA, Moriarty T, Ferguson J, Nijs S et al. The effect of Systematic review and Meta-analysis Open limb fractures Tobramycin-loaded poly(methyl methacrylate) (PMMA) vancomycin Results suggest important reduction in infection risk with the use of additional local antibiotics (OR = 0.30; 95% CI 0.22 to 0.40) compared to standard systemic prophylaxis alone. Patient local antibiotic prophylaxis when treating open limb fractures: A systematic review and powder aqueous . treated for open fractures that received local antibiotic prophylaxis had an infection rate of 4.6%, whereas open fractures treated with standard systemic prophylaxis alone had an infection meta-analysis. Bone Joint Res. 2018;7(7):447-456. doi:10.1302/2046- 3758.77.BJR-2018- rate of 16.5% (p < 0.001). 0043.R1 Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles Systematic review and Meta-analysis Colorectal surgery Not stated The SSI rate in the bundle group was 7.0% (328/4,649) compared with 15.1% (585/3,866) in a standard care group. The pooled effect of 13 studies with a total sample of 8,515 patients reduce the risk of surgical site infections in patients undergoing colorectal surgery? A shows that surgical care bundles have a clinically important impact on reducing the risk of SSI compared to standard care with a CI of 0.55 (0.39-0.77; P = . 0005). systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015;158(1):66-77.

Mocanu V, Dang JT, Ladak F, Tian C, Wang H, Birch D, et al. Antibiotic use in prevention of anal Systematic review and Meta-analysis Incision and drainage of anorectal abscesses Ciprofloxacin, Amoxicillin–clavulanate, Fistula rate in subjects receiving antibiotics was 16% versus 24% in those not receiving postoperative antibiotics. A statistically significant protective effect of antibiotic treatment to against fistulas following incision and drainage of anorectal abscesses: A systematic review and meta- fistula was found in 3 studies (OR 0.64; CI 0.43-0.96; P = 0.03). analysis. Am J Surg. 2019;217(5):910-917. doi:10.1016 /j.amjsurg.2019.01.015 Nguyen AL, Pronk AA, Furnée EJ, Pronk A, Davids PH, Smakman N. Local administration of Systematic review and Meta-analysis Surgical Excision of Sacrococcygeal Pilonidal Sinus Disease: Gentamicin 3 RCTs comparing excision of pilonidal sinus disease and primary wound closure with versus without gentamicin collagen sponge demonstrating a trend towards reduced SSIs after gentamicin collagen sponge in surgical excision of sacrococcygeal pilonidal sinus disease: a administration of gentamicin collagen sponge (absolute risk reduction 20 %, 95 % CI 1-41 %, p = 0.06). Wound healing (absolute risk reduction 22 %, 95 % CI 32- 77 %, p = 0.42) and systematic review and meta-analysis of the literature. Tech Coloproctol. 2016;20(2):91-100. recurrence rate (absolute risk reduction 8 %, 95 % CI 7-22 %, p = 0.30) were not significantly different between both groups. Administration of a gentamicin collagen sponge after surgical doi:10.1007/s10151-015-1381-7 excision of sacrococcygeal pilonidal sinus disease showed no significant influence on wound healing and recurrence rate, but a trend towards a reduced incidence of surgical site infections.

Musters GD, Burger JW, Buskens CJ, Bemelman WA, Tanis PJ. Local Application of Gentamicin Systematic review Abdominoperineal Resection Gentamicin, paromomycin, metronidazole, cefazolin The reoperation rate for perineal wound infection described in 3 studies ranged between 2 and 5 % for the local application of gentamicin and between 0 and 9 % when no topical antibiotics in the Prophylaxis of Perineal Wound Infection After Abdominoperineal Resection: A were applied. 3 studies reported a statistically significant reduction in hospital stay (p < 0.05). Systematic Review. World Journal of Surgery. 2015;39(11):2786-2794. DOI: 10.1007/s00268- 015-3159-5 Yang L, Tang Z, Gao L, Li T, Chen Y, Liu L, et al. The augmented prophylactic antibiotic could Systematic review and Meta-analysis Transrectal ultrasound-guided biopsy of the prostate (TRUSBP) Ciprofloxacin, Bactrim DS, gentamicin, Amoxicillin– clavulanate, Findings favored the augmented antibiotic use for all primary outcomes: bacteriuria (RR 4.25, 95 % CI 1.96-9.22, P = 0.0003), bacteremia (RR 4.96, 95 % CI 2.31-10.67, P < 0.0001), drug-resistant be more efficacious in patients undergoing transrectal prostate biopsy: a systematic review cefoxitin, Amikacin, Cefuroxime, Tobramycin. bacteriuria (RR 3.52, 95 % CI 1.41-8.78, P = 0.007), drug-resistant bacteremia (RR 4.94, 95 % CI 2.17-11.24, P = 0.0001), fever (RR 2.75, 95 % CI and meta-analysis. Int Urol Nephrol. 2016;48(8):1197- 1207. doi:10.1007/s11255-016- 1.63-4.62, P = 0.0001), UTI (RR 3.76, 95 % CI 2.57-5.48, P < 0.00001), and hospitalization (RR 3.90, 95 % CI 2.64-5.75, P < 0.00001). 1299-7 Cussans A, Somani BK, Basarab A, Dudderidge TJ. The role of targeted prophylactic Systematic review and Meta-analysis Transrectal ultrasound-guided biopsy of the prostate (TRUSBP) Fluoroquinolone, ampicillin/clavulanic acid, cefadroxil, ceftriaxone, Post-biopsy infections rates were higher in groups given empirical prophylaxis (4.55%, 95% CI 3.80–5.44) compared with groups receiving targeted antimicrobial prophylaxis based on the results antimicrobial therapy before transrectal ultrasonography-guided prostate biopsy in gentamicin, trimethoprim/sulfamethoxazole, cephalexin, of rectal culture (0.72%, 95% CI 0.44–1.18; P < 0.001). Sepsis rates were also higher in groups given empirical prophylaxis (2.21%, 95% CI 1.71–2.87) compared with targeted prophylaxis (0.48%, reducing infection rates: a systematic review. BJU Int. 2016;117 (5):725-731. , cephalosporins, amoxicillin/clavulanate, cephotaxime, 95% CI 0.26–0.88) (P < 0.001). The absolute risk reduction was 3.83% (95% CI 2.94–4.73). doi:10.1111/bju.13402 , amikacin, , cefuroxime, amoxicillin, levofloxacin, , aztreonam.

Noreikaite J, Jones P, Fitzpatrick J, Amitharaj R, Pietropaolo A, Vasdev N, et al. Fosfomycin Systematic review and Meta-analysis Transrectal ultrasound-guided biopsy of the prostate (TRUSBP) Fosfomycin and non-fosfomycin antimicrobials Lower UTIs were found in the fosfomycin cohort (M-H 0.20; 95% CI 0.13-0.30; p < 0.00001). Urine cultures from patients given fosfomycin showed significantly lower resistance rates (M-H vs. quinolone-based antibiotic prophylaxis for transrectal ultrasound- guided biopsy of the 0.27; 95% CI 0.15-0.50; p < 0.0001). prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2018;21(2):153-160. doi:10.1038/s41391-018-0032-2 La Regina D, Mongelli F, Fasoli A, Lollo G, Ceppi M, Saporito A, et al. Adverse Events after Systematic review and Meta-analysis Endoscopic colonoscopy Ampicillin and/or sulbactam, cefuroxime, levofloxacin or ceftazidime, All included studied showed a reduction in the rate of postoperative adverse events. The overall incidence rate was 2.4 and 19.9% in treatment and control groups, respectively. Endoscopic Resection for Colorectal Lesions: A Meta-Analysis on the Antibiotic Prophylaxis. cefmetazole Dig Dis 2020;38:15-22. doi: 10.1159/000502055 Zeng S, Zhang Z, Bai Y, Sun Y, Xu C. Antimicrobial agents for preventing urinary tract Systematic review and Meta-analysis Cystoscopy Fluoroquinolones, cephalosporins, and aminoglycosides Antibiotic prophylaxis may have little or no effect on the risk of systemic UTI compared with placebo or no treatment (RR 1.12, 95% CI 0.38 to 3.32) but may reduce the risk of symptomatic UTI infections in adults undergoing cystoscopy. Cochrane Database Syst Rev. (RR 0.49, 95% CI 0.28 to 0.86). For adverse effects, inconclusive results were found as no study reported serious adverse events. 2019;2(2):CD012305. Published 2019 Feb 21. doi:10.1002/14651858.CD012305. pub2 Carey MM, Zreik A, Fenn NJ, Chlosta PL, Aboumarzouk OM. Should We Use Antibiotic Systematic review and Meta-analysis Cystoscopy Democlocycline, ceftriaxone, norfloxacin, fosfomycin, trimethoprim, The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta- Analysis. Urol Int. ciprofloxacin, trometamol, levofloxacin developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for 2015;95(3):249-259. doi:10.1159/000381882 symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria. Brand M, Grieve A. Prophylactic antibiotics for penetrating abdominal trauma. Cochrane Systematic review Routine laparotomy 0 There is currently no information from RCTs to support or not the use of antibiotics for patients with penetrating abdominal trauma. Database of Systematic Reviews 2019, Issue 12. Art. No.: CD007370. DOI: 10.1002/14651858.CD007370.pub4. Kim SH, Yu HC, Yang JD, Ahn SW, Hwang HP. Role of prophylactic antibiotics in elective Systematic review and Meta-analysis Elective Laparoscopic cholecystectomy Cefazoline, Cefuroxime, cefotaxime, ceftriaxione In RCTs, prophylactic antibiotics did not prevent deep SSI (RR 1.10; 95% CI 0.45–2.69; p=0.84) but reduced overall SSI (RR 0.70, 95% CI 0.53–0.94; p=0.02), and superficial SSI (RR 0.58, 95% CI laparoscopic cholecystectomy: A systematic review and meta-analysis. Ann Hepatobiliary 0.42–0.82; p=0.01). However, prospective studies showed prophylactic antibiotics did not reduce superficial SSI (RR 0.35, 95% CI 0.01–8.40; p=0.52) but reduced overall SSI (RR 0.12, 95% CI Pancreat Surg. 2018;22(3):231-247. doi:10.14701/ahbps. 0.04–0.35, p=0.0001). Finally, results of retrospective studies found that antibiotic prophylaxis did not reduce overall SSI (RR 1.59, 95% CI [0.30–8.32], p=0.58). Pooled data of all designs 2018.22.3.231 showed similar results from RCTs, that prophylactic antibiotics were not effective in preventing deep SSI (RR 1.01 95% CI 0.46–2.21; p=0.98) but effective in reducing superficial SSI (RR 0.61, 95% CI [0.45–0.83], p=0.002) and overall SSI (RR 0.67, 95% CI 0.51–0.88; p=0.003). Matsui Y, Satoi S, Hirooka S, Kosaka H, Kawaura T, Kitawaki T. Reappraisal of previously Systematic review and Meta-analysis Elective Laparoscopic cholecystectomy Not stated Antibiotic administration was found to reduce significantly rates of SSI (RR 0.71; 95% CI 0.51-0.99), distant (RR 0.37; 95% CI 0.19-0.73) and overall infections (RR 0.50; 95% CI 0.34-0.75). reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews. BMJ Open. 2018;8(3): e016666. Published 2018 Mar 16. doi:10.1136/bmjopen-2017-016666 Liang B, Dai M, Zou Z. Safety and efficacy of antibiotic prophylaxis in patients undergoing Systematic review and Meta-analysis Elective Laparoscopic cholecystectomy Ciprofloxacin, cefuroxime, cefazolin, cefotetan, cefotaxime, Antibiotic prophylaxis reduced SSI incidence (RR 0.61; 95% CI 0.45-0.82; P = 0.001) and global infections (RR 0.55, 95% CI 0.38 to 0.79, P = 0.001) during hospitalization or after discharge, and elective laparoscopic cholecystectomy: A systematic review and meta- analysis. J ceftriaxone and ceftazidime postoperative length of hospital stay (weighted mean difference -0.16, 95% CI -0.28 to -0.04, P = 0.008). No results for adverse events were reported. Gastroenterol Hepatol. 2016;31(5):921-928. doi:10.1111/jgh.13246 Subgroup analyses showed that 2 doses (RR 0.16, 95% CI 0.06-0.47) of antibiotic and 3-10 doses (RR 0.46; 95% CI 0.27-0.80)of antibiotic significantly reduced SSi incidence compared with placebo or no antibiotics. Single dose of antibiotic administration did not (RR 0.87; 95% CI 0.59-1.30). Hajibandeh S, Popova P, Rehman S. Extended Postoperative Antibiotics Versus No Systematic review and Meta-analysis Emergency cholecystectomy. Ampicillin/sulbactam, Amoxicillin/clavulanic, Cefoxitin, No statistically significant difference was found between the 2 groups in terms of postoperative infectious complications (OR 0.94; P = .79), SSI (OR = 1.13, P = .72), postoperative morbidity (OR Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Cefoxitin/cefaclor 0.93; P = .70), postoperative non infectious complications (OR 0.85, P = .57), urinary tract infections (OR = 0.69, P = .55), pneumonia (OR = 0.33, P = .14), length of hospital stay (mean Calculous Cholecystitis: A Systematic Review and Meta-Analysis. Surg Innov. 2019;26(4):485- difference = 0.78, P = .25), postoperative mortality (risk difference = -0.00, P = .65), and need for readmission (OR = 0.87, P = .70). 496. Foster D, Kethman W, Cai LZ, Weiser TG, Forrester JD. Surgical Site Infections after Systematic review and Meta-analysis Appendectomy Not stated Pooled SSI rate among patients who received preoperative antibiotics was 13.6 infections per 100 appendectomies (95% CI 8.9–18.2 infections/ 100 appendectomies) compared to 18.9 Appendectomy Performed in Low and Middle Human Development-Index Countries: A infections per 100 appendectomies (95% CI 8.0–29.7 infections/100 appendectomies) in studies where the use of preperative antibiotic was not specified. Systematic Review. Surg Infect (Larchmt). 2018;19(3):237-244. doi: 10.1089/sur.2017.188 Erdas E, Medas F, Pisano G, Nicolosi A, Calò PG. Antibiotic prophylaxis for open mesh Systematic review and Meta-analysis Open mesh repair of groin hernia. Cefazolin, Amoxicillin/clavulanate, Ampicilin/sulbactam, Levofloxacin Results from RCTs showed that antibiotic prophylaxis significantly reduced the overall incidence of SSI from 4.8 % to 3.2 % (OR 0.68, 95 % CI (0.51-0.91). However, results were non-significant repair of groin hernia: systematic review and meta-analysis. Hernia. 2016;20 (6):765-776. (OR 0.76; 95 % CI 0.56-1.02) after the removal of two outlier studies. Deep SSI incidence was very low (0-0.7 %) and the effect of antibiotic prophylaxis was not significant (OR 0.80, 95 % CI doi:10.1007/s10029-016-1536-0 0.32-1.99). Boonchan T, Wilasrusmee C, McEvoy M, Attia J, Thakkinstian A. Network meta- analysis of Systematic review and Meta-analysis Open mesh repair of groin hernia. First‐generation cephalosporins (intramuscular cephaloridine), The results indicated that β‐lactam/β‐lactamase inhibitors were the most effective antibiotic prophylaxis compared with placebo, with a pooled RR of 0·44 (95% CI 0.25 -0.75), followed by antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery. Br J second‐generation cephalosporins (intravenous cefonicid), β‐ 1st‐generation cephalosporins, with a pooled RR of 0.62 (95% CI 0·42-0·92). Compared with 1st‐generation cephalosporins, β‐lactam/β‐lactamase inhibitors were most effective, whereas Surg. 2017;104(2):e106-e117. doi:10.1002/bjs.10441 lactam/β‐lactamase inhibitors (intravenous amoxicillin– clavulanate) 2nd‐generation cephalosporins and fluoroquinolones were least effective; however, these effects were not statistically significant, with pooled RRs of 0·70 (0·36 -1·38), 1·32 (0·55-3·16) and and fluoroquinolones. 1·23 (0·71-2·15) respectively. β‐Lactam/β‐lactamase inhibitors and fluoroquinolones seemed to be superior to 2nd-generation cephalosporins but this was not statistically significant (RRs 0·54 (0·21-1·39) and 0·94 (0·36-2·45) respectively. Finally, fluoroquinolone prophylaxis was associated with a 75% higher risk of SSI compared to β‐lactam/β‐lactamase inhibitors (RR 1.75; 95% CI 0·80-3·82), but this was not statistically significant.

Baltodano PA, Chattha A, Johnson PK, Kittredge J, Ricci JA, Patel A. Postoperative Prophylactic Systematic review and Meta-analysis Ventral hernia repair (VHR) Cefazolin or Ciprofloxacin. Pooled results showed that the overall SSI incidence among patients receiving postoperative antibiotics was 14.63 % (95% CI, 9.977–20.91) compared to 35.56% (95% CI, 28.93–42.79) Antibiotics Reduce Surgical Site Infection Rates after Ventral Hernia Repair: A Systematic among the patients who did not. Overall, prophylactic postoperative antibiotic use was associated with significantly fewer SSIs in comparison with the control group (OR 0.31; 95% CI, Review. The American Surgeon. 2019; (11):1228-1233 0.1829–0.5277, P < 0.01) Subgroup analysis excluding patients who underwent laparoscopic VHRs, revealed an incidence of SSIs of 15.12% among patients receiving postoperative antibiotics compared to 36.3% among patients who did not (OR 0.31; 95% CI, 0.1626-0.5865, P < 0.01). Weiss, Eric; McClelland, Paul; Krupp, James; Karadsheh, Murad; Brady, Mary Sue . Use of Systematic review Ventral hernia repair (VHR) Not stated One study directly evaluated the use of prolonged antibiotics (PPA) with closed suction drain after incisional VHR and results suggested that prolonged antibiotic prophylaxis lowered SSIs (OR Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia 0.235, 95% CI 0.090–0.617, P 5 0.003). The rate of infection occurred in 37 % of patients not treated with prolonged antibiotic prophylaxis (only antibiotics at the time of the drain) and 15 % Repair. The American Surgeon, 2019; 85 (4), 403-408 of patients treated with PPA. Two other study found no significant effect with PPA on SSI rates. Almeida RA, Hasimoto CN, Kim A, Hasimoto EN, El Dib R. Antibiotic prophylaxis for surgical site Systematic review Liver transplantation Ceftriaxone plus metronidazole versus ampicillin‐sulbactam plus One trial (Nikeghbalian 2010) reported no differences between ceftriaxone plus metronidazole and ampicillin‐sulbactam plus ceftizoxime for prophylaxis of bacterial infection among liver infection in people undergoing liver transplantation. Cochrane Database Syst Rev. 2015;(12). ceftizoxime transplant recipients in terms of rates of positive culture and changes in antibiotic type, fever episodes, and bacterial infection at specific sites (wound, urine, respiratory tract, blood, intra‐ doi:10.1002/14651858.CD010164.pub2 abdominal site) during the hospital course and mortality. Song T-R, Rao Z-S, Qiu Y, et al. Fluoroquinolone prophylaxis in preventing BK polyomavirus Systematic review and Meta-analysis Renal transplantation Fluoroquinolone, levofloxacin, ciprofloxacin, quinolones 2 RCTs and 4 cohort studies compared fluoroquinolones vs no fluoroquinolone for BKV infection prevention and reported no difference in the incidence of BK viremia at 1 year post‐ infection after renal transplant: A systematic review and meta-analysis. Kaohsiung J Med Sci. transplantation. A higher incidence of BK viremia was found in those who received any fluoroquinolone compared with those who received none (14.4% vs. 7.1%, p = 0.04), and patients who 2016;32(3):152-159. doi:10.1016/J.KJMS.2016.01.004 received fluoroquinolone for 30 days had a higher incidence of BK viremia compared with those who received either fluoroquinolone for less than 30 days or did not receive fluoroquinolone (16.5% vs. 7.6% or 7.1%; p = 0.02). Hanadi H. Alrammaal, Hannah K. Batchelor, R. Katie Morris and Hsu P. Chong. Efficacy of Systematic review Cesaerian section Cefuroxime, Ampicillin/sulbactam There were no studies evaluating Cefuroxime concentrations in obese women undergoing C-section. For non-obese women, Cefuroxime plasma concentrations ranged from perioperative cefuroxime as a prophylactic antibiotic in women requiring caesarean section: a 9.85 to 95.25 mg/L within 30–60 min of administration a single dose of 1500 mg, which is above the minimum inhibitory concentration (8 mg/L) for up to 3 h post-dose. No studies reported systematic review. European Journal of Obstetrics and Gynecology and Reproductive Biology. on Cefuroxime concentration in adipose tissue. SSI rates were 4.7% and 6.8% after administration of a single 1500 mg dose of Cefuroxime administrated after cord clamping. 2019;242:71-78. https://doi.org/10.1016/j. ejogrb.2019.08.022

Bollig C, Nothacker M, Lehane C, Motschall E, Lang B, Meerpohl J. Prophylactic antibiotics Systematic review and Meta-analysis Cesaerian section Penicillin, Cephalosporin, Ceftriaxone, Ampicillin, , Women who were given antibiotics preoperatively were 28% (RR 0.72, 95% CI 0.56–0.92) less likely to show infectious morbidity compared with those who received antibiotics after cord before cord clamping in cesarean delivery: a systematic review. Acta Obstet Gynecol Azithromycin, Cefathiamidine, Ceftazidime, Ceftizoxime, Lincosamide, clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (RR 0.57, 95% CI 0.40–0.82) and the risk of wound infection by 38% (RR 0.62, 95% CI 0.47–0.81) in those who Scand. 2018;97(5):521-535. doi:10.1111/aogs.13276 Clindamycin received antibiotics preoperatively as compared to those who received antibiotics after cord clamping. For other maternal infections no significant differences were identified. The risk for neonatal outcom s(deaths attributed to infection, sepsis, neonatal antibiotic treatment, intensive care unit admission or antibiotic‐related adverse events) was statistically different when antibiotics were given before or after cord clamping. Nabhan AF, Allam NE, Hamed Abdel-Aziz Salama M. Routes of administration of antibiotic Systematic review and Meta-analysis Cesaerian section Cephalosporins (cefamandole, cefazolin, , cefotaxime, Non-significant difference between intravenous antibiotics and antibiotic irrigation for endometritis (RR 0.95, 95% CI 0.70-1.29, P = 0.74) nor wound infection (RR 0.49, 95% CI 0.17-1.43, P = prophylaxis for preventing infection after caesarean section. Cochrane Database Syst Rev. and cefoxitin) and (mezlocillin). 0.19). Sensitivity analysis did not change the overall results neither for endometritis (RR 0.87, 95% CI 0.62-1.23) nor wound infections (RR 0.42, 95% CI 0.11-1.61). 2016;(6):CD011876. Published 2016 Jun 17. doi:10.1002 /14651858.CD011876.pub2 Liu D, Zhang L, Zhang C, Chen M, Zhang L, Li J et al. Different regimens of penicillin antibiotics Systematic review and Meta-analysis Cesaerian section Ampicillin, ampicillin-salbactam, mezlocillin, piperacillin, One study reported maternal sepsis as an outcome and showed no statistically significant difference between single dose and multidose administration in maternal sepsis (RR 3.05, 95% CI given to women routinely for preventing infection after cesarean section: A systematic review piperacillin-, amoxyicillin, and amoxicillin-clavulani 0.13 to 73.41). Five studies reported endometritis as an outcome and showed no statistically significant difference between single dose and multidose administration in endometritis (RR 1.05, and meta analysis. Medicine (Baltimore). 2018;97(46):e11889. 95% CI 0.70-1.60). No statistical difference was found between the one-day and three-day groups in rates of maternal sepsis (RR 4.04, 95% CI 0.20–81.69), however a three-day course of doi:10.1097/MD.0000000000011889 antibiotics probably reduced the rate of endometritis in the mother (RR 3.49, 95% CI 1.07–11.33). No statistically significant difference was reported between administration before skin incision and after umbilical cord clamping in sepsis (RR 0.67, 95%CI 0.20–2.26), however administration before skin incision may lower the rate of endometritis (RR 0.21, 95%CI 0.10–0.45). No statistical difference was reported between intravenous injection and lavage groups in rates of endometritis in the mother (RR 1.02, 95% CI 0.38–2.70). Finally, combination of penicillins with an inhibitor probably lowered cases of endometritis (RR 0.39, 95% CI 0.21–0.72).

Carter EB, Temming LA, Fowler S, Eppes C, Gross G, Srinivas SK et al. Evidence- Based Systematic review and Meta-analysis Cesaerian section Not stated SSI rate was significantly lower after implementing an evidence-based bundle (baseline pooled rates 6.2% vs 2.0% intervention, pooled RR 0.33, 95% CI 0.25-0.43). Evidence-based bundles Bundles and Cesarean Delivery Surgical Site Infections: A Systematic Review and Meta- were also associated with a lower rate of superficial or deep surgical site infection (baseline pooled rate 5.9% vs 1.1% intervention, pooled RR 0.19, 95% CI 0.12-0.32). The rate of analysis. Obstetrics and Gynecology. 2017 Oct;130(4):735-746. DOI: endometritis was low at baseline and not significantly different after intervention (baseline pooled rate 1.3% vs 0.9% intervention, pooled RR 0.57, 95% CI 0.31-1.06). 10.1097/aog.0000000000002249. Gallagher M, Jones DJ, Bell-Syer SV. Prophylactic antibiotics to prevent surgical site infection Systematic review and Meta-analysis Breast cancer surgery Azithromycin, Clarithromycin, Augmentin, , Cefazolin, Pooling of the results demonstrated that preoperative prophylactic antibiotics probably lowered SSI incidence for patients undergoing breast cancer surgery without reconstruction (RR 0.67; after breast cancer surgery. Cochrane Database Syst Rev. 2019;9(9): CD005360. Dicloxacillin, Cefonicid, Ampicillin‐sulbactam, Gentamycin 95% CI 0.53-0.85). Sensitivity analysis excluding 3 studied still favoured preoperative antibioitc prophylaxis compared to no antibiotic (RR 0.74;95% CI 0.57- 0.96). One study compared doi:10.1002/14651858.CD005360.pub5. perioperative antibiotic to no antibiotic and findings were inconclusive for SSI incidence (RR 0.11, 95% CI 0.01-1.95). Soteropulos CE, Tang SYQ, Poore SO. Enhanced Recovery after Surgery in Breast Systematic review Breast reconstruction Cephalosporin Preoperative antibiotic administration was recommended in the majority of protocols (cephalosporin if no allergy) for autologous reconstruction patients. For alloplastic reconstruction, no Reconstruction: A Systematic Review. J Reconstr Microsurg. 2019 Nov;35(9):695- 704. doi: studies reporting the use of postoperative antibiotics was retrieved. 10.1055/s-0039-1693699. Epub 2019 Aug 1. PMID: 31370092. Zapata-Copete J, Aguilera-Mosquera S, García-Perdomo HA. Antibiotic prophylaxis in breast Systematic review and Meta-analysis Breast reduction surgery Cefonicid, Azythromicin, Cefazolin, Cephalexin, Cloxacillin, Overall SSI incidence was 10.5% for antibiotic group compared to 18.7% for the no antibiotic or placebo group.The overall risk difference for SSI was −0.08 (95% CI −0.14– reduction surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. Levofloxacin, Clindamycin −0.03), favoring antibiotic prophylaxis compared to placebo. 2017;70(12):1689-1695. doi:10.1016/j.bjps.2017.08.005 Guo T, Chen B, Rao F, Wu P, Liu P, Liu Z, et al. Identifying the superior antibiotic Systematic review and Meta-analysis Breast surgeries Ampicilin, amoxicilin, cefazolin, cefonicid, azithromiycin, Results revealed that antibiotic prophylaxis significantly reduced the postoperative infection rate (OR 0.57; 95% CI 0.45–0.72); Test Z = 4.83; P = .000). prophylaxis strategy for breast surgery: A network meta-analysis. Medicine (Baltimore). clarithromycin, tetracycline,flucloxacillin, cloxacillin, gentamicin, 2019;98(17):e15405. doi:10.1097/MD.0000000000015405 dicloxacillin. Lynch JM, Sebai ME, Rodriguez-Unda NA, Seal S, Rosson GD, Manahan MA. Breast Systematic review and Meta-analysis Implant insertion in augmentation mammoplasty procedures. Gentamicin, Bacitracin and Cephalosporin Resulsts showed significant reductions in clinical infection (RR 0.52, 95% CI 0.33–0.81) and capsular contracture (RR 0.36, 95% CI 0.16–0.83) as a result of antibiotic irrigation. Pocket Irrigation with Antibiotic Solution at Implant Insertion: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg. 2018;42(5):1179-1186. doi: 10.1007/s00266-018- 1166-2 Ayeleke RO, Mourad S, Marjoribanks J, Calis KA, Jordan V. Antibiotic prophylaxis for elective Systematic review and Meta-analysis Hysterectomy Cephalosporin versus penicillin; cephalosporin versus tetracycline; Vaginal hysterectomy: results showed that, compared to placebo, women who received antibiotic prophylaxis had fewer total postoperative infections (RR 0.28, 95% CI 0.19- 0.40), UTI (RR hysterectomy. Cochrane Database Syst Rev. 2017;6(6):CD004637. doi: antiprotozoal versus lincosamide; ephalosporin versus antiprotozoal 0.58, 95% CI 0.43-0.77), pelvic infections (RR 0.28, 95% CI 0.20-0.39), and postoperative fevers (RR 0.43, 95% CI 0.34-0.54). No differences between any of the 4 antibiotics comparison groups 10.1002/14651858.CD004637.pub2 (cephalosporin vs penicillin; cephalosporin vs tetracycline; antiprotozoal vs lincosamide; antiprotozoal vs lincosamide) for any of the primary outcomes, except that fewer cases of total postoperative infection and postoperative fever were reported in women who received cephalosporin than in those who received antiprotozoal. Finally, results were unavailable for most primary outcomes for comparisons of combined antibiotics to a single on (cephalosporin+antiprotozoal vs cephalosporin, cephalosporin+antiprotozoal vs antiprotozoal, penicillin+antiprotozoal vs penicillin). Abdominal hysterectomy: results showed that, compared to placebo, women who received antibiotic prophylaxis of any class had fewer total postoperative infections (RR 0.38, 95% CI 0.21- 0.67), abdominal wound infections (RR 0.51, 95% CI 0.36-0.73), UTIs (RR 0.41, 95% CI 0.31-0.53), pelvic infections (RR 0.50, 95% CI 0.35-0.71), and postoperative fevers (RR 0.59, 95% CI 0.50- 0.70). No difference was found when comparing cephalosporin vs penicillin for any of the primary outcomes and results were unclear when comparing penicillin antiprotozoal vs penicillin. Pop-Vicas A, Johnson S, Safdar N. Cefazolin as surgical antimicrobial prophylaxis in Systematic review and Meta-analysis Hysterectomy Cefazolin, cefoxitin or cefotetan In terms of SSI incidence, cefazolin use was not inferior to its comparator in 12 of 13 individual RCTs included in the analysis. The meta-analysis summary estimate showed a significantly hysterectomy: A systematic review and meta-analysis of randomized controlled trials. higher SSI risk with cefazolin versus cefoxitin or cefotetan (risk ratio, 1.7; 95% CI, 1.04–2.77; P = .03). However, most studies included nonstandardized dosing and duration of antimicrobial Infect Control Hosp Epidemiol. 2019;40(2):142-149. doi:10.1017/ice.2018.286 prophylaxis, had indeterminate or high risk of bias, did not include patients with gynecological malignancies, and/or were older RCTs not reflective of current clinical practices.

Vander Poorten, V., Uyttebroek, S., Robbins, K.T., Rordigo J, de Bree R, Laenen A et al. Systematic review and Meta-analysis Head and Neck Surgery Cefazolin, ampicillin-sulbactam, and amoxicillin-clavulanate, 15 studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Results of 5 RCTs comparing clindamycin to ampicillin- Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic and clindamycin sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50-4.97, p = 0.001). Review and Meta-Analysis. Adv Ther. 2020; 37, 1360–1380. https://doi. org/10.1007/s12325-020-01269-2 Moldovan ID, Agbi C, Kilty S, Alkherayf F. A Systematic Review of Prophylactic Antibiotic Systematic review Endoscopic endonasal transsphenoidal surgery Cefazolin, Ceftriaxone, Ceftazidime, Vancomycin, Clarithromycin, The review only included a limited number (4) observational studies assessing the effectiveness of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS. No meta- Use in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Lesions. World Amoxicillin/clavulanate, Cephalexin analysis was conducted but none of the evidence was able to provide conclusive evidence about the benefits of use to prevent 30 days post-EEST infectious complications such as meningitis Neurosurg. 2019;128:408-414. doi:10.1016/j.wneu.2019.05.082 and sinusitis.

Vijendren, A., Borsetto, D., Barker, E., Manjaly, J. G., Tysome, J. R., Axon, P. R., Donnelly, N. Systematic review Cochlear implant (CI) surgery Cefazolin, Clindamycin / vancomycin, cefuroxime and co- amoxicla Intraoperative prophylactic antibiotics should be given to all patients undergoing CI. Findings of two studies (Hirsch et al. and Basavaraj et al) on prolonged prophylactic antibiotics showed P., & et al. A systematic review on prevention and management of wound infections from increased infection rates in contradiction to a third study (Garcia-Valdecases et al.). Almosnino et al. study found no difference in wound inections between group with prolonged AP and cochlear implantation.Clinical otolaryngology, 2019; 44 (6), group without. 2 studies looked at cefazolin as the antibiotic type given (Hirsch et al. and Almonisno et al.) and their results suggest its use to prevent post wound infections. 1059-1070. https://doi.org/10.1111/coa.13444 Loggini A, Vasenina VI, Mansour A, Das Horowitz P, Goldenberg et al. Management of Systematic review Brain injury surgery and treatment Not stated Results of the review did not provide details on perioperative antibiotic prophylaxis for civilians with penetrating brain injury nor evidence supporting its use. civilians with penetrating brain injury: A systematic review. J Crit Care. 2020;56: 159-166. doi:10.1016/j.jcrc.2019.12.026 Nuyen B, Kandathil CK, Laimi K, Rudy SF, Most SP, Saltychev M. Evaluation of Antibiotic Systematic review and Meta-analysis Rhinoplasty Penicillin or amoxicillin, with or without β-lactamase inhibition, Antibiotic treatments started on induction or perioperatively were administered intravenously, whereas therapy with antibiotics started postoperatively was administered orally. Dosages and Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis. JAMA Facial Plast Surg. clavulanate, erythromycin, Ampicillin, durations varied with the duration of postoperative administration, ranging from 5 to 12 days. Two RCTs compared groups with antibiotic prophylaxis of different lengths of treatment (pre and 2019;21(1):12-17. doi:10.1001/jamafacial.2018.1187 post) and 3 RCTs compared antibiotics with placebo (3) or no treatment (1). The overall rate of infections within the pooled sample was 5.54% in cases and 6.53% in controls.The pooled RR of infection when comparing postoperative antibiotics with placebo or no treatment, pre or peri operatively, was 0.92 (95% CI, 0.35-2.43; P = 0 .86). The pooled RR of infection when comparing postoperative antibiotics with placebo or no treatment (excluding preoperative or perioperative antibiotics) is presented in Figure 3. The pooled RR was 0.43 (95% CI, 0.18-1.04; P = .06). Results did not favoured postoperative antibiotic prophylaxis after rhinoplasty compared to pre-, peri and no treatment or placebo.

Habib AM, Wong AD, Schreiner GC, Satti KF, Riblet NB, Johnson HA et al. Postoperative Systematic review and Meta-analysis Surgery for maxillofacial fractures Penicillin G IV, Penicillin VIK, Amoxicillin, Augmentin, Vancomycin, The addition of postoperative antibiotic prophylaxis to a standard preoperative and/or perioperative antibiotic regimen showed no significant difference in the risk of SSI (RR 1.11; 95% CI prophylactic antibiotics for facial fractures: A systematic review and meta-analysis. Amoxicillin/clavulanate, Cefotaxin, Mezlocillin/oxacillin, Cefotaxime, 0.86-1.44, P > .1). Subgroup analysis found no significant differences in the risk of SSI when focusing either on mandibular fractures (RR 1.22; 95% CI 0.92- 1.62) or open surgical techniques Laryngoscope. 2019;129(1):82-95. doi:10.1002/lary.27210 Metronidazole, Cephazolin (RR1.02; 95% CI: 0.62-1.67). A sensitivity analysis did not find any significant differences in risk when restricting to RCTs (RR = 1.00; 95% CI: 0.61-1.67) or cohort studies (RR 1.21; 95% CI: 0.89-1.63). Huang J, Wang X, Chen X, Song Q, Liu W, Lu L. Perioperative Antibiotics to Prevent Acute Systematic review and Meta-analysis Ophthalmologic surgeries Vancomycin/moxifloxacin Results suggested that the rate of postoperative endophthalmitis was lower in the group that received intracameral vancomycin/moxifloxacin group compared to the one who did not (OR Endophthalmitis after Ophthalmic Surgery: A Systematic Review and Meta- Analysis. PLoS 0.20, 95% CI 0.10-0.42, p<0.0001, I2 = 45%). Subgroup analysis revealed that the results in the moxifloxacin group were homologous (OR 0.21, 95%CI 0.12-0.37, p<0.00001, I2 = 0%) but One. 2016;11(11):e0166141. Published 2016 Nov 8. doi:10.1371 heterogeneous in the vancomycin group (OR 0.11, 95% CI 0.01-1.55, p = 0.10, I2 = 81%). No significant differences were found between subconjunctival antibiotic injections compared to no /journal.pone.0166141 anitibiotics (OR 1.67, 95% CI 0.55-5.05, p = 0.36, I2 = 85%) and compared to topical antibiotics or (povidone-iodine) neither (OR 0.43, 95% CI 0.15-1.20, p = 0.11, I2 = 68%). Significant differences were found comparing subconjunctival antibiotic injections to intracameral antibiotic (OR 3.76, 95% CI 1.92-7.37, p = 0.0001, I2 = 0%) and antibiotic irrigation (OR 10.07, 95% CI 3.09-32.88, p = 0.0001). Al-Abduljabbar KA, Stone DU. Risks of cefuroxime prophylaxis for postcataract Systematic review Cataract surgery Cefuroxime, Penicillins Evidence was found to support the use of cefuroxime in penicillin-allergic patients. Compounding or dilutional errors were associated with ocular toxicity, but the incidence and risk of this endophthalmitis. Middle East Afr J Ophthalmol 2017;24:24-9. Available from: http: occurrence are unknown. Evidence may support interventions that reduce the risk of dilutional errors. The association of cefuroxime injection with toxic anterior segment syndrome (TASS) //www.meajo.org/text.asp?2017/24/1/24/205301 has not be proven, evidence suggested that cefuroxime administration could be included as a standard measure to reduce the incidence of TASS. Bowen RC, Zhou AX, Bondalapati S, Lawyer T, Snow K, Evans P et al. Comparative analysis of Systematic review and Meta-analysis Cataract surgery Cefuroxime, moxifloxacin and vancomycin Pooled results favoured the use of intracameral antibiotics at the end of cataract surgery (OR 0.20; 95% CI 0.13-0.32; P<0.00001) compared various controls (postoperative topical, the safety and efficacy of intracameral cefuroxime, moxifloxacin and vancomycin at the end subconjunctival or oral antibiotics). The average weighted postoperative endophthalmitis incidence rates with intracameral cefuroxime, moxifloxacin and vancomycin were 0.0332%, 0.0153% of cataract surgery: a meta-analysis. Br J Ophthalmol. 2018; 102(9):1268-1276. and 0.0106%, respectively. Secondary analyses showed no difference in efficacy between intracameral plus topical antibiotics versus intracameral alone (P>0.3).The safety analysis found that doi:10.1136/bjophthalmol-2017-311051 intracameral more complications (contamination, dilution errors and TASS along with macular toxicity) than vancomycin or moxifloxacin. Findings also showed minimal toxicity for moxifloxacin and dosing errors were the main causes of toxicities with cefuroxime. Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, McDonnell PJ. Perioperative Systematic review and Meta-analysis Cataract surgery Vancomycin, Gentamycin, Penicillin, Cefuroxime, Levofloxacin, One study found reduced risk of endophthalmitis when combining intracameral cefuroxime and topical levofloxacin (risk ratio (RR) 0.14, 95% confidence interval (CI) 0.03 to 0.63; 8106 antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Chloramphenicol-sulfadimidine, Gatifloxacin, Prednisolone participants; high‐certainty evidence) or using intracameral cefuroxime alone (RR 0.21, CI 0.06 to 0.74; 8110 participants; high‐certainty evidence) compared with placebo, and an uncertain Database Syst Rev. 2017;2(2):CD006364. doi:10.1002 effect when using topical levofloxacin alone compared with placebo (RR 0.72, CI 0.32 to 1.61; 8103 participants; moderate‐certainty evidence). 2 studies found that the combination of /14651858.CD006364.pub3 antibiotic injections during surgery and topical antibiotics reduced the risk of endophthalmitis compared with topical antibiotics alone (RR 0.33, 95% CI 0.12-0.92 for periocular penicillin and topical chloramphenicol‐sulfadimidineand; and RR 0.20, 95% CI 0.04-0.91 for intracameral cefuroxime and topical levofloxacin). One study did not detect differences in endophthalmitis between fixed versus separate instillation of gatifloxacin and prednisolone. Another study found no evidence of a difference in endophthalmitis when comparing subconjunctival versus retrobulbar antibiotic injections (RR 0.85, 95% CI 0.55-1.32).Two studies reported visual acuity as an outcome: the first study found the same mean visual acuity for both fixed versus separate instillation of gatifloxacin and prednisolone groups at 20 days postoperation, whereas the second study found uncertain evidence about the difference in the proportion of eyes with final visual acuity greater than 20/40 following endophthalmitis between groups receiving intracameral cefuroxime with or without topical levofloxacin compared with no intracameral cefuroxime (RR 0.69, 95% CI 0.22- 2.11).

Kessel L, Flesner P, Andresen J, Erngaard D, Tendal B, Hjortdal J. Antibiotic prevention of Systematic review and Meta-analysis Cataract surgery Cefazolin, cefuroxime and moxifloxacin and vancomycin The RCT conducted as a European multicenter trial was stopped after recruitment of 16 603 patients as the treatment effect was so marked that it was deemed unethical to continue the postcataract endophthalmitis: a systematic review and meta-analysis. Acta Ophthalmol. study. A total of 29 cases of clinically suspected endophthalmitis were detected and and a statistically significant difference (RR 0.21; 95% CI: 0.08-0.55) was found for the rate of 2015;93(4):303-317. doi:10.1111/aos.12684 endophthalmitis which was 0.6 per 1000 surgeries for intracameral cefuroxime group at the conclusion of surgery compared to 3.0 per 1000 surgeries for the no cefuroxime group. Results from non‐randomized studies showed that patients treated with intracameral cefazolin, cefuroxime and moxifloxacin had lower risk of endophthalmitis, whereas no significant effect was found for intracameral vancomycin. The relative risk [RR (95% confidence interval)] of endophthalmitis was reduced to 0.10 (0.06; 0.17) in patients receiving cefazolin, 0.09 (0.05; 0.15) in patients receiving cefuroxime, 0.22 (0.10; 0.50) in patients receiving moxifloxacin and 0.30 (0.02; 3.90) in patients receiving vancomycin.

Bokhari R, You E, Zeiler FA, Bakhaidar M, Bajunaid K, Lasry O, et al. Effect of Intrawound Systematic review and Meta-analysis Non-spinal surgery Intra-wound vancomycin powder Across all subspecialties, except for cranioplasties, results showed an overall beneficial effect of vancomycin use on SSI incidence (OR 0.25; 95% CI 0.12–0.52). The use of vancomycin did not Vancomycin on Surgical Site Infections in Nonspinal Neurosurgical Procedures: A result in the emergence of resistant infections or in a significant increase in the proportion of infections caused by gram-negative organisms. Systematic Review and Meta-Analysis. World Neurosurgery. 2019; 123:409-417.e7. DOI: 10.1016/j.wneu.2018.10.168. Texakalidis P, Lu VM, Yolcu Y, Kerezoudis P, Alvi MA, Parney IF, et al. Impact of Powdered Systematic review and Meta-analysis Neurosurgery Intra-wound vancomycin powder Intra-wound vancomycin powder was associated with significantly lower risk for overall SSIs in both cranial (OR 0.33; 95% CI: 0.18-0.60; P = .0003; I2 = 45%) and spine surgery (OR 0.41; 95% Vancomycin on Preventing Surgical Site Infections in Neurosurgery: A Systematic Review and CI 0.30-0.57; P < .001; I2 = 47%). Separate analyses were conducted for superficial and deep SSIs, in spine surgery, and a significant difference was found only for deep SSIs (OR 0.31; 95% CI: Meta-analysis. Neurosurgery. 2019;84(3):569-580. doi: 10.1093/neuros/nyy288 0.22-0.45; P < .001; I2 = 29%). Subgroup analyses for different vancomycin powder dosages (1 g vs 2 g vs composite dose) did not revealed dose-related effect of vancomycin.

Xu, H., HU, F., HU, H, Sun W, Jiao W, Li R et al. Antibiotic prophylaxis for shunt surgery of Systematic review and Meta-analysis Shunt surgery Cloxacillin, Methicillin, Vancomycin, Sulfamethoxazole, Cephalothin, Statistically significant difference in infection rate was found between antibiotic prophylaxis use and no antibiotics (RR 0.59; 95% CI 0.38- 0.90, P < 0.05). children: a systematic review. Childs Nerv Syst. 2016;32(2):253-258. doi: 10.1007/s00381- Fampicin, Cefuroxime 015-2937-6 Alotaibi AF, Hulou MM, Vestal M, Asgarzadeh M, Cote D, Bi W et al. The Efficacy of Systematic review and Meta-analysis Craniotomy Not stated Antibiotic prophylaxis lowered meningitis rates after neurosurgery (OR 0.34; 95% CI0.18-0.63). Subgroup analysis based on Gram-negative coverage, blinding design, and study quality Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta- showed no statistically significant difference among these groups (P> 0.05 for all). A meta-regression on surgery duration (P = 0.52) and on antibiotics duration (P = 0.59) did not show Analysis. World Neurosurg. 2016;90:597-603.e1. doi: 10.1016/j.wneu. significant differences in the results among studies. 2016.02.048 Abraham P, Nayan L, Acosta M, Gholmie J, DawoodH, Vestal M et al. Antibacterial Systematic review and Meta-analysis Cranial surgery , glycopeptides, third generation cephalosporins, Pooled SSIs incidence of patients who received a single antibiotic or a combination of 2 or more antibiotics was 6.00% (95% CI 4.80-7.50%; P-heterogeneity<0.01). Incidence of SSI was 1.00% prophylaxis for gram-positive and gram-negative infections in cranial surgery: A meta- antibiotics combination and penicillin-family antibiotics (95% CI 0.40-2.60%) for non-MRSA gram-positive bacterial infections; 2.70% (95% CI 0.90%, 8.00%) for gram-negative bacterial infections; 6.00% (95% CI=4.50%, 7.80%) for gram negative, and analysis. J Clin Neurosci. 2017;45:24-32. doi:10.1016/j.jocn.2017.07.039 non-MRSA gram-positive bacterial infections; and 11.3% (95% CI 7.20-17.4%) for gram negative and MRSA gram-positive bacterial infections. Subgroup analysis revealed an effect modification by drug class (P=0.05) and infection type (P-interaction=0.01). Lincosamides (2.70%), glycopeptides (2.80%), 3rd-generation cephalosporins (5.30%; n=2), antibiotics combination (4.90%), and penicillin-family antibiotics (5.90%) offered better coverage against infections than 1st- generation cephalosporins (22.0%) Jaworski R, Kansy A, Dzierzanowska-Fangrat K, Maruszewski B. Surgery: Where Are We and Systematic review Pediatric Cardiac surgery Cefazolin, second-generation cephalosporin, gentamicin, penicillin In 14 studies time of first antibioitc dose was within 60 minutes before skin incision, and for one study it was administered at the induction of anesthesia. In 3 studies an additional dose was Where Do We Go? A Systematic Review. Surgical Infections. 2019; 20 (4), 253- with b-lactamase inhibitors given at ECC initiation (same dosage as first dose), two studies focused on an additional dose of cefazolin (25 mg/kg and 30 mg/ 100 mL respectively) given at ECC priming. Six groups of 260.http://doi.org/10.1089/sur.2018.272 authors reported intraoperative redosing every 3-4 hours whereas one study reported an additional dose at the start of rewarming, one an additional dose after separation from ECC, and one if ECC lasted more than two hours or the overall operation time exceeded 6 hours. Postoperative cefazolin administration was given every six hours (2 studies) or eight hours (5 studies) or in only two doses, except in neonatal infants (<7 days), in whom the reported redosing was every 12 hours (2 studies). Postoperative redosing was every 8 hours (1 study) for cefuroxime and 12 hours for gentamicin (1 study). The postoperative prophylaxis duration was 24 hours after surgery (3 studies) or for 48 hours (10 studies). In one study, administration was continued until all chest tubes had been removed and in one study at 48 hours after the removal of the tubes. The antibiotic prophylaxis in children with delayed sternal closure was described in eight of the reports. In these children, the reported standard antibiotic prophylaxis was continued for 24 hours (1 study), 48 hours (1 study), or until the removal of all chest tubes after sternal closure (1 study). A change from standard antibiotic prophylaxis to another schedule was reported in 5 studies if the sternum was left open post-operatively. In one study, postoperative change to vancomycin alone was described whereas four studied found combination of two antibiotics: cefazolin + aztreonam (1 study), cefazolin + vancomycin (1 study), and vancomycin + gentamicin (2 studies).

Liu Z, Norman G, Iheozor-Ejiofor Z, Wong JK, Crosbie EJ, Wilson P. Nasal decontamination Systematic review and Meta-analysis Elective cardiac surgery Anerdian, mupirocin, acetate One study compared mupirocin (2% contained in a base of 400 and polyethylene glycol 3350) with a placebo for elective cardiac surgery and findings showed unclear for the prevention of surgical site infection in carriers. Cochrane difference in SSI risk between the two groups (RR 1.60, 95% CI 0.79-25. The second study compared Anerdian (iodine 0.45% to 0.57% (W/V), chlorhexidine acetate 0.09% to 0.11% (W/V)) Database Syst Rev. 2017;5(5):CD012462. Published 2017 May 18. with no treatment. As for mupirocin, findins were unclear about evidence of a difference in SSI risk following treatment with Anerdian compared with no treatment (RR 0.89, 95% CI 0.06- doi:10.1002/14651858.CD012462.pub2 13.08). Ramos JA, Salinas DF, Osorio J, Ruano-Ravina A. Antibiotic prophylaxis and its appropriate Systematic review Urological procedures Levofloxacin, Cefazolin, Ciprofloxacin, Nitrofurantoin, Piperacilin 8 studies evaluated the effectiveness of antibiotic prophylaxis regardless of the presence of asymptomatic bacteriuria (AB). Of these, four studies showed a significant reduction in the rate of timing for urological surgical procedures in patients with asymptomatic bacteriuria: A tazobactam, Ciprofloxacina, Metronidazole, Tinidazole infections in the intervention group compared with placebo, or with the same antibiotic therapy but using different durations of therapy. Four studies found no significant differences in systematic review. Arab J Urol. 2016;14(3):234-239. doi:10.1016/j.aju. 2016.05.002 infectious complications between the intervention and comparison arms. Only one study assessed the duration of antibiotic prophylaxis in patients with AB and findings suggested no significant differences between preoperative single-dose (30–60 min) with an antibiotic treatment lasting 3–15 days until the urine was sterile prior to surgery.

Di Spiezio Sardo A, Calagna G, Scognamiglio M, O'Donovan P, Campo R, De Wilde Systematic review Hysteroscopy Not stated The results showed the effect antibioitc prophylaxis in the prevention of post-operative intrauterine adhesions (IUA) was difficult to evaluate as it has been used in association with other R. Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review. prevention strategies in most studies included in the review. Only 4 studies reported information on antibioitc administration amongst them only one on intra and post-antibiotic prophylaxis European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2016;203:182-192. alone who revealed that only 1.07% of patients who had undergone resectoscopic myomectomy presented IUA. DOI: 10.1016/j.ejogrb.2016.05.050. Guo T, Zeng N, Yang J, Wu P, Liu P, Liu Z et al. The clinical effects of antibiotic prophylaxis for Systematic review and Meta-analysis Hysteroscopy Cefazolin, doxycycline, cefoxilin, cefuroxime Results revealed no statistical significance between prophylactic antibiotics group and control group (test for OR: Z = 0.50, P = .616; 95% CI: 0.987–1.008). Findings suggested that antibiotic hysteroscopic procedures: A meta-analysis. Medicine (Baltimore). 2019;98(34):e16964. prophylaxis brought no clinical benefit for patients who underwent hysteroscopic procedures. The sensitivity analysis of diagnosis-only group and surgical resection group revealed the same doi:10.1097/MD.0000000000016964 results (P = 0.509 and 0.780). Gandra S, Trett A, Alvarez-Uria G, Solomkin JS, Laxminarayan R. Is the efficacy of antibiotic Systematic review and Meta-analysis Appendectomy, cesarean section, and colorectal Cefoxitin, Cefotetan, Cefazolin, Metronizadole, Ciprofloxacin, Results showed no statistically significant increase in SSIs over time for appendectomy (adjusted odds ratio [aOR] per year, 1.03; 95% CI,0.92–1.16; P=.57), cesarean section (aOR per year, prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of surgery Levofloxacin, Ofloxacin, Perfloxacin, Prulifloxacin 1.01; 95% CI, 0.96–1.05; P=.80), and Transrectal Prostate Biopsy (aOR per year, 0.95; 95% CI, 0.77–1.18; P=.67). However, there was a significant increase in SSIs proportion following randomized control trials. Infect Control Hosp Epidemiol. 2019;40 (2):133-141. colorectal surgery (aOR per year, 1.049; 95% CI, 1.03–1.07; P<.001). doi:10.1017/ice.2018.295 Gouvêa M, Novaes Cde O, Pereira DM, Iglesias AC. Adherence to guidelines for surgical Systematic review General surgery, Otorhinolaryngology, Gynecology, Urology Not stated 5 studies (specialties were: Urology, Otorhinolaryngology, General surgery and multiple specialties) addressed the outcome appropriate indication of antibiotic prophylaxis and contained a antibiotic prophylaxis: a review. Braz J Infect Dis. 2015;19(5):517-524. doi: and multiple specialties (General surgery, Cardiac surgery, prevalence of 70.3% to 95% of adequate indication. 14 studies (specialties were: Urology, Gynecology, General surgery and multiple specialties) addressed the outcome administration of 10.1016/j.bjid.2015.06.004 Neurosurgery, Gynecology-obstetrics, Ophthalmology, antibiotics at the correct time and percentages ranged from 12.73% to 100%. 6 studies (specialties were: General Surgery, Gynecology and multiple specialties) addressed the outcome of Orthopedics, Otorhinolaryngology, Urology, Vascular, Plastic, inappropriate indication of antibiotic prophylaxis, with results varying from 2.3% to 100% . 10 studies (specialties were: General Surgery, Urology, and multiple specialties) described correct Thoracic and Oral and maxillofacial surgery). antibiotic choice and values ranged from 22% to 95%. 9 studies (specialties were: General Surgery and multiple specialties) described the outcome of adequate discontinuation of antibiotics with results ranging between 5.8% and 91.4%. 13 studies (specialties were: General Surgery, Urology, Gynecology and multiple specialties) the outcome adequate antibiotic prophylaxis and showed percentages ranging from 0.3% to 84.5%. Srisung W, Teerakanok J, Tantrachoti P, Karukote A, Nugent K. Surgical prophylaxis with Systematic review and Meta-analysis Multiple surgeries, cardiac, orthopaedic, urological Gentamicin, Cephalothin, flucloxacillin, Dicloxacillin, Cefuroxime, The pooled RR of developing postoperative acute kidney infections (AKI) for patients who received gentamicin prophylaxis, regardless of surgery type, was 1.66 (95% CI 1.32- 2.09), whereas gentamicin and acute kidney injury: a systematic review and meta-analysis. Ann Transl Med. Flucloxacin, vancomycin, clindamycin, Coamoxiclav, Metronidazole, the pooled risk difference (RD) was 0.05 (95% CI 0.03-0.07). The pooled RR of AKI for patients treated with gentamicin prophylaxis for orthopedic surgery only was 2.99 (95%1.84-4.88), 2017;5(5):100. doi:10.21037/atm.2017.03.06 Teicoplanin whereas the pooled RD was 0.07 (0.04, 0.11). The pooled RR of cardiac surgery only was 1.29 (0.77, 2.17), whereas the pooled RD of this analysis was 0.05 (95% CI −0.03-0.13). The pooled RR of urologic surgery only was not applicable as only one study was retrieved and reported zero AKI events. de Jonge SW, Gans SL, Atema JJ, Solomkin JS, Dellinger PE, Boermeester MA. Timing of Systematic review and Meta-analysis Gastrointestinal, orthopedic, vascular, traumatology Vancomycin, Cefuroxime, moxifloxacin, Gentamicin, Metronidazole, The broadly accepted recommendation to administer prophylaxis within a 60-minute time frame prior to incision could not be substantiated by the following results.No significant preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: gynecology, and cardiac surgery. amoxicilin, flucoxacilin difference was found between antibiotic prophylaxis administered 120–60 minutes prior to incision compared to administration 60–0 minutes prior to incision. Studies investigating A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(29):e6903. different timing intervals within the last 60 minutes time frame reported contradictive results. The risk of SSI almost doubled when antibiotic prophylaxis was administered after first doi:10.1097/MD.0000000000006903 incision (OR:1.89; 95%CI 1.05–3.40) and was 5 times higher when administered more than 120 minutes prior to incision (OR 5.26; 95%CI 3.29– 8.39).

Purba AKR, Setiawan D, Bathoorn E, Postma MJ, Dik JH, Friedrich AW. Prevention of Surgical Systematic review General surgery, Neurosurgery, Cardiothoracic surgery, Cefuroxime, metronidazole, Cefotetan, gentamicin, vancomycin, The SSI rates ranged from 0 to 71.1% with costs amounting to US$480-22,130. Twenty-four bacteria were identified as causative agents of SSIs. Gram negatives were the dominant causes of Site Infections: A Systematic Review of Cost Analyses in the Use of Prophylactic Antibiotics. Obstetric Obstetric gynecology, Oncology, Orthopaedic mupirocin, cefotaxime, cefoxitin, cefuroxime, Rifampicin, SSIs especially in general surgery, neurosurgery, cardiothoracic surgery, and obstetric cesarean sections. Front Pharmacol. 2018;9:776. Published 2018 Jul 18. doi: 10.3389/fphar.2018.00776 surgery. Ceftriaxone, Ampicillin, cloxacillin, rifamycin, Clindamycin, amikacin. Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E et al. Intraoperative Systematic review and Meta-analysis Hernia repair, Cesarean section, Breast cancer surgery, Single cephalosporin, cephalosporin drug combination, single Findings showed that prophylactic intravenous antibiotics administered before caesarean incision reduce SSI risk compared with after neonatal umbilical cord clamping (RR 0.59, 95% CI interventions for preventing surgical site infection: an overview of Cochrane Reviews. Colorectal surgery penicillin and penicillin drug combinations 0.44 -0.81) and that antibiotic prophylaxis probably also reduced SSI risk after caesarean section compared with no prophylaxis (RR 0.40, 95% CI 0.35-0.46). Results showed that Cochrane Database Syst Rev. 2018;2(2):CD012653. Published 2018 Feb 6. preoperative antibiotics reduce SSI risk compared with placebo after breast cancer surgery (RR 0.74, 95% CI 0.56 -0.98). Results suggested that antibiotic prophylaxis probably reduced SSI doi:10.1002/14651858.CD012653.pub2 risk compared with placebo for hernia repair (RR 0.67, 95% CI 0.54-0.84). No clear difference in SSI risk was found between short‐term compared with long‐term duration antibiotics in colorectal surgery (RR 1.05 95% CI 0.78- 1.40) López-Cano, Kraf M, Curell A, Puig-Asensio M, Balibrea J, Armengol-Carrasco M, et al. Use Systematic review and Meta-analysis Incision closure β-lactams and aminoglycosides Results showed a significant reduction of SSI incidence with the application of antibiotic agents before primary surgical incision closure (RR 0.49, 95% CI 0.37–0.64). SSI was assessed within of Topical Antibiotics before Primary Incision Closure to Prevent Surgical Site Infection: A 30 days of the surgical procedure. After removal of studies with uncertain quality and time assessment of infection less than 30 days, the beneficial effect of the use of topical antibiotic Meta-Analysis. Surgical Infections 2019; à (4).261-270.http://doi. agents was maintained (RR 0.58, 95% CI 0.39–0.86) org/10.1089/sur.2018.279 Hussain Z, Curtain C, Mirkazemi C, Zaidi STR. Peri-operative Medication Dosing in Adult Obese Systematic review Cesaerian section, Gynaecological (colorectal surgery), Cefazolin and cefoxitin Four studies (one randomised and three case control) examined the effect of obesity on cefazolin dosing and the associated incidence of SSIs. None of the studies found any significant Elective Surgical Patients: A Systematic Review of Clinical Studies. Clin Drug Investig 38, 673– Cardiac, orthopaedic and general surgery, and all types of difference in SSI incidence when comparing higher doses (3g or 4g) with routinely recommended doses (1-2g). The standard 2-g dose of cefazolin appeared effective in the prevention of SSI. 693 (2018). https://doi.org/10.1007/s40261-018-0662-0 surgeries. However, a cohort study on cefoxitin reported a higher SSI incidence in obese patients who received a 2g dose compared to non-obese patients who were given a 1g dose (21.4 vs. 0%).