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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(1966年1月—2007年12月)、EMBASE(1988年1月—2007年12月)、Cochrane Collaboration Reviews(1993年1月—2007年12月)、中国生物医学期刊文献数据库(CMCC,1979年—2007年12月)、CNKI数字图书馆(1979年1月—2007年12月)进行相关的随机对照试验(RCT)的检索、质量评价和资料提取,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57篇,符合纳入标准11篇进入Meta分析。结果表明:术前清洁尿的患者,预防性抗生素能显著降低TPB术后1周内菌尿和术后发热的比率,疗效分析相对危险度(RR值)及其95%CI分别为0.36(0.25～0.52)和0.39(0.24～0.63),但不能减少菌血症的发生率,RR值及其95%CI为0.92(0.57～1.48);各疗程预防性抗生素能明显减少TPB术后菌尿的发生率;喹诺酮及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。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;喹诺酮及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;各疗程预防性抗生素能明显减少TPB术后菌尿的危险。
Objective To analyze whether prophylactic antibiotics can reduce the postoperative complications of infection in patients undergoing transrectal prostate biopsy (TPB) before surgery for cleaning urine. Methods The inclusion criteria, exclusion criteria and search strategies for the development of the original literature were established. MEDLINE (January 1966-December 2007), EMBASE (January 1988-December 2007), Cochrane Collaboration Reviews (January 1993- (December 2007), China Biomedical Journal Literature Database (CMCC, 1979 - December 2007) and CNKI Digital Library (January 1979 - December 2007) to conduct a randomized controlled trial (RCT) , Quality evaluation and data extraction, using Meta analysis of Rev Man 4.2 software. Results A total of 68 randomized controlled trials were retrieved, 57 were excluded, and 11 were eligible for inclusion in the Meta-analysis. The results showed that prophylactic antibiotics can significantly reduce the rate of bacteriuria and postoperative fever within one week after TPB. The relative risk (RR) and 95% CI of efficacy analysis were 0.36 (0.25 ~ 0.52) and 0.39 (0.24-0.63), respectively, but the incidence of bacteremia was not decreased. The RR and its 95% CI were 0.92 (0.57-1.48). The prophylactic antibiotics of each course significantly reduced bacteriuria Incidence of; quinolone and quinolone combined with nitroimidazole can significantly reduce the risk of bacteriuria after TPB. Conclusions Preoperative antibiotics can reduce the incidence of bacteriuria and fever in TPB patients, but can not reduce the incidence of bacteremia. Both quinolone and quinolone combined with nitroimidazole can significantly reduce the incidence of TPB The risk of bacteriuria; preventive treatment of antibiotics can significantly reduce the risk of bacteriuria after TPB.