ABSTRACT
ABSTRACT Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.
ABSTRACT
Esta dissertação trata-se de um estudo de caso que teve como unidade de análise o Núcleo de Avaliação de Tecnologias em Saúde (NATS) do Instituto Nacional de Traumatologia e Ortopedia (INTO) em sua participação na construção de ferramenta que possibilita o desenvolvimento de pesquisas voltadas à avaliação de tecnologias em saúde (ATS). A artroplastia de joelho, considerada como tecnologiaem saúde, pode apresentar complicações apesar das melhorias observadas nas próteses ortopédicas e nos resultados cirúrgicos. Como fonte de dados, registros de artroplastias internacionais apresentam um grande potencial para realização de avaliações clínicas e econômicas e têm permitido detectar falhas relacionadas às próteses ortopédicas. Assim, visando o incremento da participação deste NATS na Rede Brasileira de Avaliação de Tecnologia em Saúde (REBRATS), disponibilizando informações relevantes e avaliações tanto do procedimento de artroplastia quanto das tecnologias a ele relacionadas, o estudo apresentou como objetivos: descrever as práticas internacionais no processo de construção, análise dos dados e uso das informações dos Registros de artroplastias; descrever a participação do NATS no projeto institucional de construção do Registro de Artroplastia de Joelho (RAJ) do INTO, com a perspectiva de realização de ATS; além de elaborar plano de análise das informações do RAJ para avaliação e monitoramento das tecnologias relacionadas às artroplastias, no âmbito institucional e junto ao Ministério da Saúde (MS). Desenvolvido durante o ano de 2012, o estudo apresentou abordagem qualitativa para exposição e discussão dos resultados. Para revisão de literatura foram utilizados livros, manuais, legislação, artigos, além dos meios de difusão da informação do próprio MS, como sites, revistas e publicações específicos, referentes à avaliação de tecnologia em saúde e registros de artroplastias...
This dissertation is about a study case that had as unit of analysis the NATS (Nucleo of Health Technology Assessment) of the INTO (NationalInstitute of Traumatology and Orthopedy) in its participation in building tool that makes possible the development of researches aimed at assessment health technologies (HTA). The knee arthroplasty, considered as technology in healthcare, can present complications despite the improvements observed in the orthopedic prostheses and surgical results. As a source of data, international Arthroplasties registers present a great potential for conducting clinical and economic assessments and it have allowed the detection of orthopedic prosthesesfailures. Therefore, aiming at the increment of participation of NATS in the BrazilianNetwork for Health Technology Assessment (REBRATS), providing relevant information and assessments of both the arthroplasty procedure as the technologies related to it, the study had the following objectives: to describe the international practices in the construction process, data analysis and use of information from arthroplasties registers; to describe the NATSs participation in the institutional project construction Knee Arthroplasty Register (RAJ) of the INTO, with the prospect of performing HTA; addition, to elaborate plan for analysis of information from RAJ for assessment and monitoring of technologies related to arthroplasty, at the institutional environment and with the Ministry of Health (MS). Developed during the year 2012, the study presented qualitative approach to expose and discuss of the results. To review the literature were used books, manuals, legislation, articles, beyond the means of information dissemination MS itself, such as websites, magazines and publications specific, referring to the health technology assessment and arthroplastiesregisters...