Routine Postoperative Antibiotic Prophylaxis Offers No Benefit After Hepatectomy...

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Routine Postoperative Antibiotic Prophylaxis Offers No Benefit After Hepatectomy—A Systematic Review And Meta-Analysis

May 12, 2022

HEIDELBERG, GERMANY – On May 12, 2022, Liver Surgery Research’s new research, “Routine Postoperative Antibiotic Prophylaxis Offers No Benefit After Hepatectomy—A Systematic Review And Meta-Analysis,” authored by Anastasia Murtha-Lemekhova, Juri Fuchs, Miriam Teroerde, Ute Chiriac, Rosa Klotz,Daniel Hornuss, Jan Larmann, Markus A. Weigand, and Katrin Hoffmann was published. This manuscript was published by the open access journal Antibiotics (MDPI), which has an impact factor of 4.639, and ranks 26/92 in the "Infectious Diseases" category and 75/275 in the "Pharmacology & Pharmacy" category in the Web of Science.

Background: Prophylactic antibiotics are frequently administered after major abdominal surgery including hepatectomies aiming to prevent infective complications. Yet, excessive use of antibiotics increases resistance in bacteria. The aim of this systematic review and meta-analysis is to assess the efficacy of prophylactic antibiotics after hepatectomy (postoperative antibiotic prophylaxis, POA).

Method: This systematic review and meta-analysis was completed according to the current PRISMA guidelines. The protocol has been registered prior to data extraction (PROSPERO registration Nr: CRD42021288510). MEDLINE, Web of Science and CENTRAL were searched for clinical reports on POA in hepatectomy restrictions. A random-effects model was used for synthesis. Methodological quality was assessed with RoB2 and ROBINS-I. GRADE was used for the quality of evidence assessment.

Results: Nine comparative studies comprising 2987 patients were identified: six randomized controlled trials (RCTs) and three retrospectives. POA did not lead to a reduction in postoperative infective complications or have an effect on liver-specific complications—post-hepatectomy liver failure and biliary leaks. POA over four or more days was associated with increased rates of deep surgical site infections compared to short-term administration for up to two days (OR 1.54; 95% CI [1.17;2.03]; p = 0.03). Routine POA led to significantly higher MRSA incidence as a pathogen (p = 0.0073). Overall, the risk of bias in the studies was low and the quality of evidence moderate.

Conclusion: Routine POA cannot be recommended after hepatectomy since it does not reduce postoperative infection or liver-specific complications but contributes to resistance in bacteria. Studies into individualized risk-adapted antibiotic prophylaxis strategies are needed to further optimize perioperative treatment in liver surgery. To learn more about this study, visit https://www.mdpi.com/2079-6382/11/5/649#cite.

About Liver Surgery Research

Liver Surgery Research (LSR) is a medical research group, located at Heidelberg University in Heidelberg – Germany. LSR specializes in research investigating liver regeneration after hepatectomy (liver resection) and post-hepatectomy liver failure, HCC development and treatment (especially in the context of MAFLD [metabolically associated fatty liver disease]), and rare liver lesions and diseases. LSR is the founder and leader of the RELIVE (RarE LIVEr) Initiative; a multidisciplinary project to establish evidence-based therapies for rare liver diseases. LSR is currently working on over 20 research projects and has over 100 peer reviewed published authorships. To learn more about Liver Surgery Research, visit www.liversurgeryresearch.com.

Contact:

Nicholas Murtha

Communications Manager

Liver Surgery Research at Heidelberg University

liversurgeryresearch@protonmail.com

nicholas.murtha@protonmail.com

Reference:

Murtha-Lemekhova, Anastasia, Juri Fuchs, Miriam Teroerde, Ute Chiriac, Rosa Klotz, Daniel Hornuss, Jan Larmann, Markus A. Weigand, and Katrin Hoffmann. 2022. "Routine Postoperative Antibiotic Prophylaxis Offers No Benefit after Hepatectomy—A Systematic Review and Meta-Analysis" Antibiotics 11, no. 5: 649. https://doi.org/10.3390/antibiotics11050649