Data from: Reappraisal of previously reported meta-analyses on antibiotic prophylaxis for low-risk laparoscopic cholecystectomy: an overview of systematic reviews

Introduction: Many researchers have addressed over-dosage and inappropriate use of antibiotics. Many meta-analyses have investigated antibiotic prophylaxis for low-risk laparoscopic cholecystectomy with the aim of reducing unnecessary antibiotic use. Most of these meta-analyses have concluded that prophylactic antibiotics are not required for low-risk laparoscopic cholecystectomies. This study aimed to assess the validity of this conclusion by systematically reviewing these meta-analyses. Methods: A systematic review was undertaken. Searches were limited to meta-analyses and systematic reviews. PubMed and Cochrane Library electronic databases were searched from inception until March 2016 using the following keyword combinations: “antibiotic prophylaxis”, “laparoscopic cholecystectomy”, and “systematic review or meta-analysis”. Two independent reviewers selected meta-analyses or systematic reviews evaluating prophylactic antibiotics for laparoscopic cholecystectomy. All of the randomized controlled trials (RCTs) analyzed in these meta-analyses were also reviewed. Results: Seven meta-analyses regarding prophylactic antibiotics for low-risk laparoscopic cholecystectomy that had examined a total of 28 RCTs were included. Reviewing of these meta-analyses revealed 48 miscounts of the number of outcomes. Six RCTs were inappropriate for the meta-analyses; one targeted patients with acute cholecystitis, another measured inappropriate outcomes, the original source of a third was not found, and the study protocols of the remaining three were not appropriate for the meta-analyses. After correcting the above miscounts and excluding the six inappropriate RCTs, pooled risk ratios were recalculated. These showed that, contrary to what had previously been concluded, antibiotics significantly reduced the risk of postoperative infections. The rates of surgical site, distant, and overall infections were all significantly reduced by antibiotic administration (risk ratio [95% confidence interval]; 0.71 [0.51–0.99], 0.37 [0.19–0.73], 0.50 [0.34–0.75], respectively). Conclusions: Prophylactic antibiotics reduce the incidence of postoperative infections after elective laparoscopic cholecystectomy.引言：既往诸多研究者均关注抗生素过量使用与不当应用问题。针对低风险腹腔镜胆囊切除术的抗生素预防方案，已有大量荟萃分析展开研究，旨在减少抗生素的不必要使用。此类荟萃分析大多得出结论：低风险腹腔镜胆囊切除术无需使用预防性抗生素。本研究旨在通过系统回顾上述荟萃分析，对该结论的有效性进行评估。 方法：本研究采用系统回顾方法。检索范围限定为荟萃分析与系统综述。检索数据库为PubMed及Cochrane Library电子数据库，检索时限为建库至2016年3月，检索关键词组合包括：“抗生素预防”“腹腔镜胆囊切除术”以及“系统综述或荟萃分析”。由两名独立研究者筛选针对腹腔镜胆囊切除术预防性抗生素应用的荟萃分析或系统综述。同时对上述荟萃分析所纳入的所有随机对照试验（RCT）进行回顾。 结果：最终纳入7项针对低风险腹腔镜胆囊切除术预防性抗生素应用的荟萃分析，共涉及28项随机对照试验（RCT）。对上述荟萃分析的回顾发现，共存在48处结局指标计数错误。另有6项RCT不符合本次分析标准：1项针对急性胆囊炎患者，1项采用了不当的结局指标，1项无法追溯原始文献来源，剩余3项的研究方案与本次荟萃分析要求不符。修正上述计数错误并排除6项不符合标准的RCT后，重新计算合并风险比。结果显示，与既往结论相悖，抗生素应用可显著降低术后感染风险。手术部位感染、远处感染及总体感染率均因抗生素给药而显著降低（合并风险比[95%置信区间]分别为0.71 [0.51–0.99]、0.37 [0.19–0.73]、0.50 [0.34–0.75]）。 结论：预防性抗生素可降低择期腹腔镜胆囊切除术后感染的发生率。