RESUMEN
OBJECTIVE: This study aimed to compare the efficacy of different antibiotic classes and dosages in preventing maternal infection after cesarean delivery. METHODS: Databases were searched for randomized controlled trials (RCTs) published between January 1980 and January 2021 on antibiotic use for the prevention of maternal infection after cesarean delivery. The outcomes were endometritis, febrile morbidity, and wound infection, reported as odds ratios (OR) and surface under the cumulative ranking curve analysis scores. RESULTS: A total of 31 RCTs met the inclusion criteria. In the network meta-analysis (NMA) for endometritis, pooled network OR values indicated that the following interventions were superior to placebo: cephalosporins (OR: 0.18, 95% credibility interval [CrI]: 0.07-0.45), penicillins (OR: 0.19, 95% CrI: 0.07-0.50), penicillins (multiple doses) (OR: 0.20, 95% CrI: 0.05-0.65), combination therapies (OR: 0.22, 95% CrI: 0.09-0.54), and cephalosporins (multiple doses) (OR: 0.25, 95% CrI: 0.08-0.74). In the NMA for febrile morbidity, placebo was more effective than the other interventions. In the NMA for wound infection, pooled network OR values indicated that the following interventions were superior to placebo: penicillin (OR: 0.14, 95% CrI: 0.05-0.37), cephalosporins (OR: 0.19, 95% CrI: 0.08-0.41), cephalosporins (multiple doses) (OR: 0.20, 95% CrI: 0.06-0.58), combination therapies (OR: 0.29, 95% CrI: 0.13-0.57), macrolides (OR: 0.33, 95% CrI: 0.15-0.74), and penicillins (multiple doses) (OR: 0.40, 95% CrI: 0.17-0.91). CONCLUSIONS: Compared with placebo, a single dose of commonly used antibiotics may prevent maternal infection after cesarean delivery. However, the incidence of febrile morbidity was not reduced.
Asunto(s)
Endometritis , Infección de Heridas , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Cesárea/efectos adversos , Endometritis/tratamiento farmacológico , Femenino , Fiebre/tratamiento farmacológico , Fiebre/etiología , Fiebre/prevención & control , Humanos , Metaanálisis en Red , Penicilinas/uso terapéutico , Embarazo , Infección de Heridas/tratamiento farmacológicoRESUMEN
OBJECTIVES: To discuss the demands and countermeasures for outpatients and emergency patients during the outbreak of coronavirus disease 2019 (COVID-19) in large general hospital. METHODS: By analyzing patients' demands, outpatient service system and emergency system complemented each other with the help of "internet medical" to provide online medical treatment, self-diagnosed pneumonia program, online pharmacies, outpatient appointment and online pre-examination services, open green channels for special patients, and to provide referral services for critical patients. The COVID-19 suspected patients and other common fever patients were separated from other patients. RESULTS: From January 28 to March 1, we have received 26 000 patients online, 1 856 special patients, 2 929 suspected patients and common fever patients including 31 confirmed patients, 0 case of misdiagnosis and cross-infection. CONCLUSIONS: Targeting patient's demands and taking appropriate measures are effective on meeting the needs of outpatients' and emergency patients' medical services.