Assessing Prophylactic Cephamycins Used in Colorectal Surgery: A Meta-Analysis

Abstract

Background: Cephamycins prophylactic used in colorectal surgery have been widely evaluated, but the uncertainty remains about the comparative effects of different antibiotics. The meta-analysis aimed to assess the efficacy of cephamycins compared with other agents used as prophylaxis in colorectal surgery. Methods: PubMed, EMBASE, and Cochrane Library were searched for relevant studies. A meta-analysis of randomized controlled trials (RCTs) meeting the criteria was performed using Review Manager. Results: Thirty-nine trials involving 4,755 participants were included in this metaanalysis. The cephamycins were not as effective as other antibiotics for the prevention of postoperative surgical site infection (SSI) (Risk Ratio [RR] 1.18; 95% confidence interval [CI] 1.04, 1.34; P=0.008) and had no advantages in reduction of systemic infection and distal infection. For each antibiotic belonging to cephamycins, there was no statistical difference when cefoxitin and cefotetan were compared with penicillins and cephalosporins on prevention of SSI, while cefmetazole had advantages over cephalosporins on prevention of SSI (RR 0.46; 95% CI 0.22, 0.96; P=0.04). Conclusions:The prophylactic use of cefoxitin and cefotetan in colorectal operations has no significant advantages over other antibiotics. However, cefmetazole may be effective in the prevention of postoperative infections and its efficacy should be researched further and considered by perioperative medical staff. Therefore, it is of great importance to optimize the prophylactic use of antibiotics in colorectal operations.