Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) related complications in surgical patients

Kurinchi Selvan Gurusamy; Rahul Koti; Peter Wilson; Brian R Davidson

doi:10.1002/14651858.CD010268.pub2

Profilaxis con antibióticos para la prevención de complicaciones relacionadas con el Staphylococcus aureus resistente a la meticilina (SARM) en pacientes quirúrgicos

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Referencias

References to studies included in this review

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estudios excluidos
otras referencias

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Carsenti‐Etesse 1999

Methods	RCT
Participants	Country: France Number randomised: 616 Post‐randomisation drop‐outs: not stated Revised sample size: 616 Average age: not stated Male:female ratio: not stated Inclusion criteria: 1. adults over 15 years of age with an open extra‐articular fracture of the tibia requiring reduction fixation 2. wound closure that could be performed directly or with a muscle or skin plasty (grades 1 and 2) 3. delay between fracture and surgery < 12 hours
Interventions	Participants randomly assigned to 2 groups: Group 1: antibiotic 1 (n = 316), a single 800 mg dose of pefloxacin iv at anaesthetic induction Group 2: antibiotic 2 (n = 300), 2‐day course of cefazolin iv (4 x 1 g doses/day; total dose over 2 days = 8 g) from anaesthetic induction, followed by a 3‐day course of oral oxacillin (3 x 1 g doses/day)
Outcomes	SSI and MRSA SSI
Notes	We attempted to contact the authors in September 2012 Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Quote: "In a randomised double‐blind trial…" Comment: further details of how the blinding was performed were not mentioned
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Quote: "In a randomised double‐blind trial…" Comment: further details of how the blinding was performed were not mentioned
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: this information was not available
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Goldstein 2009

Methods	RCT
Participants	Country: USA Number randomised: 1002 Post‐randomisation drop‐outs: 330 (32.9%) Revised sample size: 672 Average age: not stated Male:female ratio: not stated Inclusion criteria: people at least 18 years of age having elective colorectal surgery
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 338), a single dose of ertapenem (1 g) over 30 min within 60 min prior to the initial incision Group 2: antibiotic 2 (n = 334), a single dose of cefotetan (2 g) over 30 min within 60 min prior to the initial incision
Outcomes	MRSA SSI
Notes	We attempted to contact the authors in September 2012 Reasons for post‐randomisation drop‐outs: not stated Source of funding: not reported, however, some of the authors worked or belonged to the advisory board of a pharmaceutical company
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Hashizume 2004

Methods	RCT
Participants	Country: Japan Number randomised: 521 Post‐randomisation drop‐outs: not stated Revised sample size: 521 Average age: not stated Male:female ratio: not stated Inclusion criteria: people undergoing elective colorectal surgery
Interventions	Participants randomly assigned to 2 groups: Group 1: antibiotic 1 (n = 262), piperacillin, cefazolin, cefmetazole, or cefotiam for 1 day Group 2: antibiotic 2 (n = 259), piperacillin, cefazolin, cefmetazole, or cefotiam for 3 days
Outcomes	SSI and MRSA SSI.
Notes	We attempted to contact the authors in September 2012 Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: this information was not available
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Ishibashi 2009

Methods	RCT
Participants	Country: Japan Number randomised: 275 Post‐randomisation drop‐outs: 0 (0%) Revised sample size: 275 Average age: 68 years Male:female ratio: 161:114 (41.5% female) Inclusion criteria: elective surgery for colon cancer Exclusion criteria: people with ileus or other conditions, who could not undergo colon preparation
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 136), cefotiam or cefmetazol for 1 post‐operative dose 1 h after surgery Group 2: antibiotic 2 (n = 139), cefotiam or cefmetazol for 4 post operative doses over 2 days
Outcomes	Mortality, antibiotic‐related serious adverse events, SSI, MRSA SSI, and overall MRSA infections
Notes	We contacted the authors in September 2012, and they provided prompt replies to our questions Source of funding: no external funding (authors' replies)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "We prepared the same number of A and B in opaque and sealed envelopes, for example, total 100 opaque and sealed envelopes include 50 A and 50 B, and shuffled. Then the surgeon draws the envelope in turn when informed consent is obtained from patients on admission" (author replies)".
Allocation concealment (selection bias)	Low risk	Quote: "We prepared the same number of A and B in opaque and sealed envelopes, for example, total 100 opaque and sealed envelopes include 50 A and 50 B, and shuffled. Then the surgeon draws the envelope in turn when informed consent is obtained from patients on admission" (author replies)
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: the authors replied that the patients and healthcare providers were not blinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Comment: the authors replied that the outcome assessors were blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: there were no post‐randomisation drop‐outs
Selective reporting (reporting bias)	Low risk	Comment: all important outcomes were reported

Ishida 2001

Methods	RCT
Participants	Country: Japan Number randomised: 146 Post‐randomisation drop‐outs: 3 (2.1%) Revised sample size: 143 Average age: 63 years Male:female ratio: 89:54 (37.8% female) Inclusion criteria: people undergoing surgery for colorectal diseases Exclusion criteria: 1. not feasible to perform full mechanical bowel preparation 2. taken any antibiotics within 14 days before surgery
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 72), kanamycin 2 g/day and erythromycin 1.6 g/day were given perorally, in 4 doses for 2 days before surgery and 6 doses of cefotiam (1 gm) within 3 days of surgery Group 2: antibiotic 2 (n = 71), no pre‐operative intervention and 6 doses of cefotiam (1 gm) within 3 days of surgery All participants received mechanical bowel preparation
Outcomes	Mortality, antibiotic‐related serious adverse events, SSI, MRSA SSI, and overall MRSA infections
Notes	We contacted the authors in September 2012, and they replied promptly with answers to our questions Reasons for post‐randomisation drop‐outs: protocol violation Source of funding: no external funding (authors' replies)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "We prepared the same number of A and B in opaque and sealed envelopes, for example, total 100 opaque and sealed envelopes include 50 A and 50 B, and shuffled. Then the surgeon draws the envelope in turn when informed consent is obtained from patients on admission" (authors' replies)
Allocation concealment (selection bias)	Low risk	Quote: "We prepared the same number of A and B in opaque and sealed envelopes, for example, total 100 opaque and sealed envelopes include 50 A and 50 B, and shuffled. Then the surgeon draws the envelope in turn when informed consent is obtained from patients on admission" (authors' replies)
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: the authors replied that the patients and healthcare providers were not blinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Comment: the authors replied that the outcome assessors were blinded
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs. Imputation of missing outcome data under different scenarios showed change in conclusions
Selective reporting (reporting bias)	Low risk	Comment: all important outcomes were reported

Kaiser 1987

Methods	RCT
Participants	Country: USA Number randomised: 1057 Post‐randomisation drop‐outs: 27 (2.6%) Revised sample size: 1030 Average age: not stated Male:female ratio: not stated Inclusion criteria: people having median sternotomy
Interventions	Participants randomly assigned to 4 groups Group 1: antibiotic 1 (n = 255), cefazolin, 2 g iv at induction of anaesthesia,1 g every 4 h during operation, and 1 g every 6 h after operation for 72 h Group 2: antibiotic 2 (n = 253), as in group 1 plus gentamicin 1.5 mg/kg given iv at induction of anaesthesia Group 3: antibiotic 3 (n = 259), cefamandole, 2 g iv at induction of anaesthesia, 1 g every 2 h during operation, and 1 g every 4 h after operation for 72 h Group 4: antibiotic 4 (n = 263), as in group 3 plus gentamicin 1.5 mg/kg given iv at induction of anaesthesia
Outcomes	SSI and MRSA SSI
Notes	We attempted to contact the authors in September 2012 Reasons for post‐randomisation drop‐outs: operations cancelled (11); failure to adhere to the antibiotic regimen (9); did not undergo median sternotomy (inadvertent entry into study (7) Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "Placebo doses were not included"
Blinding of outcome assessment (detection bias) All outcomes	High risk	Quote: "Placebo doses were not included"
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Morimoto 2002

Methods	RCT
Participants	Country: Japan Number randomised: 199 Post‐randomisation drop‐outs: 18 (9%) Revised sample size: 181 Average age: 54 years Male:female ratio: 181 women (100% female) Inclusion criteria: women undergoing treatment for breast cancer
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 99), levofloxacin 200 mg daily from day after operation for 5 days Group 2: antibiotic 2 (n = 82), ofloxacin 200 mg daily from day after operation for 5 days
Outcomes	SSI and MRSA SSI
Notes	We attempted to contact the authors in September 2012 Reasons for post‐randomisation drop‐outs: tumours proved to be benign Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Saadeddin 2005

Methods	RCT
Participants	Country: UK Number randomised: 110 Post‐randomisation drop‐outs: 11 (10%) Revised sample size: 99 Average age: 71 years Male:female ratio: 53:46 (46.5% female) Inclusion criteria: people over 16 years of age accepted for PEG insertion without malignant disease Exclusion criteria: people who had received antibiotics within the 48 h preceding the PEG insertion
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 51), a single dose of 2.2 g co‐amoxiclav, made up of 1 g amoxicillin and 1.2 g co‐amoxiclav (or 2 g cefotaxime if participant was penicillin‐allergic) Group 2: antibiotic 2 (n = 48), placebo injection
Outcomes	Mortality, antibiotic‐related serious adverse events, SSI, and MRSA SSI
Notes	We contacted the authors in September 2012. Authors provided replies regarding serious adverse events related to antibiotic treatment Reasons for post‐randomisation drop‐outs: failure to complete PEG insertion after randomisation (7 cases), protocol violation (3 cases) or PEG removal by patient (1 case) Source of funding: no external funding (authors' replies)
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Randomization was done in advance using a random number generator"
Allocation concealment (selection bias)	Low risk	Quote: "study assignment cards with medication packs were kept in pharmacy"
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "The endoscopy nurse prepared the medication and the syringe out of sight of the study investigator, and covered the syringe with an opaque sleeve so that both the study investigator and the patient were ‘blinded’"
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The endoscopy nurse prepared the medication and the syringe out of sight of the study investigator, and covered the syringe with an opaque sleeve so that both the study investigator and the patient were ‘blinded’"
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs
Selective reporting (reporting bias)	Low risk	Comment: all important outcomes were reported

Saveli 2011

Methods	RCT
Participants	Country: USA Number randomised: 92 Post‐randomisation drop‐outs: not stated Revised sample size: 92 Average age: not stated Male:female ratio: not stated Inclusion criteria: people with open fractures
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 46), vancomycin (dose and frequency not stated) and cefazolin (dose and frequency not stated) from the time of presentation at ER to 24 h after surgery Group 2: antibiotic 2 (n = 46), cefazolin (dose and frequency not stated) from the time of presentation at ER to 24 h after surgery Both groups received cefazolin antibiotic prophylaxis
Outcomes	Antibiotic‐related serious adverse events, SSI, and MRSA SSI
Notes	We contacted the authors in September 2012; they replied, but no additional information was obtained Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comment: this information was not available
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Shime 2007

Methods	RCT
Participants	Country: Japan Number randomised: 24 Post‐randomisation drop‐outs: 2 (8.3%) Revised sample size: 22 Average age: not stated Male:female ratio: not stated Inclusion criteria: 1. children under 3 years old admitted for cardiac surgery to the PICU 2. carriage of MRSA in the nasal cavity, preoperatively confirmed by sampling the anterior nare, or a history of MRSA infection
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 11), vancomycin 15 mg/kg, first dose after the induction of general anaesthesia, within the hour preceding the first surgical incision, and a second, identical dose, added to the priming solution of cardio‐pulmonary bypass, based on an approximately doubled plasma volume at the onset of extracorporeal circulation. Postoperatively, the same dose was given upon admission to the PICU, and repeated every 8 h for 48 h Group 2: antibiotic 2 (n = 11), teicoplanin 8 mg/kg, first dose after the induction of general anaesthesia, within the hour preceding the first surgical incision, and a second, identical dose, added to the priming solution of cardio‐pulmonary bypass, based on an approximately doubled plasma volume at the onset of extracorporeal circulation. Postoperatively, the same dose was given upon admission to the PICU, and repeated every 24 h for 48 h An intranasal ointment of mupirocin was applied three times a day, for 3 days before the operation
Outcomes	SSI and MRSA SSI
Notes	We attempted to contact the authors in September 2012 Reasons for post‐randomisation drop‐outs: death 1 (vancomycin group); postoperative application of extracorporeal cardiopulmonary support (vancomycin group) Source of funding: not reported
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: this information was not available
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: there were post‐randomisation drop‐outs, however, imputation of missing outcome data under different scenarios did not change the conclusions
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Stone 2010

Methods	RCT
Participants	Country: USA Number randomised: 181 Post‐randomisation drop‐outs: 12 (6.6%) Revised sample size: 169 Average age: 65 years Male:female ratio: 115:54 (32% female) Inclusion criteria: people 18 years of age and older having vascular surgery and or vascular access (vascular fistula or vascular graft) procedure Exclusion criteria: 1. allergy to daptomycin or vancomycin 2. chronic wounds 3. prior colonization with MRSA 4. a continuous inpatient stay of > 72 h prior to the surgical procedure 5. an active infection requiring antibiotics preoperatively 6. history of MRSA colonisation or infection 7. HIV 8. admission for > 3 months in an acute care centre or long‐term care centre 9. dialysis
Interventions	Participants randomly assigned to 3 groups. Group 1: antibiotic 1 (n = 56), vancomycin (0 to 60 minutes prior to incision), weight‐based dose with 1 g iv for people < 80 kg, 1.5 g iv for 80‐199 kg, and 2 g iv for participants ≥ 200 kg. Participants given another dose in the OR if still there 6 h post‐incision and had a GFR of > 60 (n = 56) Group 2: antibiotic 2 (n = 51), 6 mg/kg iv daptomycin (30 minutes prior to incision) Group 3: no additional antibiotic (n = 62) Further details: all participants received cefazolin (0 to 60 minutes prior to incision), weight‐based dose with 1 g iv every 8 h for 24 h if weight < 80 kg, 2 g iv every 8 h for 24 h if weight 80‐199 kg, and 3 g iv every 8 h if weight ≥ 200 kg. Participants given another dose in the OR if still there 3 h post‐incision and had a GFR of > 60
Outcomes	SSI and MRSA SSI
Notes	We contacted the authors in September 2012: they replied, but no additional information was obtained Reasons for post‐randomisation drop‐outs: active infection, dialysis, allergy to penicillin, no surgery Source of funding: not reported, however, Dr Patrick A Stone, the primary author of this paper, is on the Speakers' Bureau for Cubist Pharmaceuticals
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Randomization was performed by staff from the Center for Health Services and Outcomes Research (CHSOR) using the statistical program SAS"
Allocation concealment (selection bias)	Low risk	Quote: "Randomization was performed by staff from the Center for Health Services and Outcomes Research (CHSOR) using the statistical program SAS"
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs. Imputation of missing outcome data under different scenarios showed change in conclusions
Selective reporting (reporting bias)	High risk	Comment: Some important outcomes, that are generally assessed, were not reported

Vuorisalo 1998

Methods	RCT
Participants	Country: Finland Number randomised: 1061 Post‐randomisation drop‐outs: 177 (16.7%) Revised sample size: 884 Average age: not stated Male:female ratio: 701:183 (20.7% female) Inclusion criteria: participants scheduled for CABG without valvular surgery Exclusion criteria: 1. people with a known allergy to cephalosporins or vancomycin 2. presence of an active infection 3. received prescribed antibiotics within the previous 2 weeks 4. people having a repeat bypass operation
Interventions	Participants randomly assigned to 2 groups Group 1: antibiotic 1 (n = 440), vancomycin 1 g slow iv infusion over 120 minutes beginning at the induction of anaesthesia plus 1 g after 12 h Group 2: antibiotic 2 (n = 444), cefuroxime 1.5 g iv over 15 minutes at the induction of anaesthesia plus 2 additional doses of 0.75 g at 8‐h intervals
Outcomes	Mortality, SSI, and MRSA SSI
Notes	We attempted to contact the authors in September 2012 Reasons for post‐randomisation drop‐outs: participant records missing (3); deviation from antibiotic regimens (78); active infection/antibiotic prescribed within previous 2 weeks (54); procedure other than CABG during the same operation (5); repeat bypass (12) Source of funding: Satakunta Fund of the Finnish Cultural Foundation
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "The patients were assigned by reference to a random number table"
Allocation concealment (selection bias)	Unclear risk	Comment: this information was not available
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: this information was not available
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: this information was not available
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: there were post‐randomisation drop‐outs. Imputation of missing outcome data under different scenarios showed change in conclusions
Selective reporting (reporting bias)	High risk	Comment: some important outcomes, that are generally assessed, were not reported

Abbreviations
< = less than
> = greater/more than
≥ = greater/more than or equal to
CABG = coronary artery bypass graft
ER = emergency room
g = gram
GFR = glomerular filtration rate
h = hour
iv = intravenous
MRSA = methicillin‐resistant Staphylococcus aureus
n = number of participants
OR = operating room
PEG = percutaneous endoscopic gastrostomy
PICU = paediatric intensive care unit
RCT = randomised controlled trial
SSI = surgical site infection

Characteristics of excluded studies [ordered by study ID]

Ir a:

estudios incluidos

Study	Reason for exclusion
Al‐Mukhtar 2009	Not an RCT
Bluhm 1984	No information on methicillin resistance status of the cultured organisms
Cann 1988	Methicillin resistance status of all staphylococcal infections was not reported
Dhadwal 2007	No information on methicillin resistance status of the cultured organisms
Diehr 2007	Not an RCT
Finkelstein 2002	Quasi‐randomised study (allocation by hospital number)
Frimodt‐Moller 1982	No information on methicillin resistance status of the cultured organisms
Kanellakopoulou 2009	Quasi‐randomised study (treatment chosen by the ward to which the patient was admitted)
Kato 2006	Not an RCT
Keighley 1979	No information on methicillin resistance status of the cultured organisms
Maki 1992	No information on methicillin resistance status of the cultured organisms
Marroni 1999	No information on methicillin resistance status of the cultured organisms
Mindermann 1993	No information on methicillin resistance status of the cultured organisms
Palmer 1995	No information on methicillin resistance status of the cultured organisms
Poon 1998	Methicillin resistance status of all staphylococcal infections was not reported
Ramos 2008	No information on methicillin resistance status of the cultured organisms
Saginur 2000	No information on methicillin resistance status of the cultured organisms
Salminen 1999	Quasi‐randomised study (allocation by birth year)
Tacconelli 2008	Quasi‐randomised study (allocation according to the first letter of the patient's name)
Tyllianakis 2010	Quasi‐randomised study (allocation according to the room number to which the patient was admitted)
Weaver 1986	No information on methicillin resistance status of the cultured organisms
Wilson 1988	No information on methicillin resistance status of the cultured organisms

Abbreviation

RCT = randomised controlled trial

Data and analyses

Open in table viewer

Comparison 1. Comparison of different regimens of prophylactic antibiotics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.1 Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 1 Mortality.
1.1 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Overall surgical site infection Show forest plot	11		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 2 Overall surgical site infection.
2.1 Cefamendole versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Cefazolin and gentamycin versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Cefazolin versus cefamendole	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Cefazolin versus cefazolin and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.5 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.6 Daptomycin and cefazolin versus cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.7 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.8 Levofloxacin versus ofloxacin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.9 One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.10 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.11 Pefloxacin versus cefazolin and oxacillin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.12 Vancomycin and cefazolin versus cefazolin (open fractures)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.13 Vancomycin and cefazolin versus cefazolin (vascular surgery)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.14 Vancomycin and cefazolin versus daptomycin and cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.15 Vancomycin versus teicoplanin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.16 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 MRSA surgical site infection Show forest plot	12		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.3 Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 3 MRSA surgical site infection.
3.1 Cefamendole versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Cefazolin and gentamycin versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Cefazolin versus cefamendole	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Cefazolin versus cefazolin and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.5 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.6 Daptomycin and cefazolin versus cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.7 Ertapenem versus cefotetan	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.8 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.9 Levofloxacin versus ofloxacin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.10 One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.11 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.12 Pefloxacin versus cefazolin and oxacillin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.13 Vancomycin and cefazolin versus cefazolin (open fractures)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.14 Vancomycin and cefazolin versus cefazolin (vascular surgery)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.15 Vancomycin and cefazolin versus daptomycin and cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.16 Vancomycin versus teicoplanin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.17 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Overall MRSA infections Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.4 Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 4 Overall MRSA infections.
4.1 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Open in table viewer

Comparison 2. Sensitivity analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.1 Comparison 2 Sensitivity analysis, Outcome 1 Mortality (kanamycin, erythromycin and cefotiam versus cefotiam).
1.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Mortality (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.2 Comparison 2 Sensitivity analysis, Outcome 2 Mortality (vancomycin versus cefuroxime).
2.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.3 Comparison 2 Sensitivity analysis, Outcome 3 Surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam).
3.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Surgical site infection (vancomycin versus teicoplanin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.4 Comparison 2 Sensitivity analysis, Outcome 4 Surgical site infection (vancomycin versus teicoplanin).
4.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.5 Comparison 2 Sensitivity analysis, Outcome 5 Surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin).
5.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Surgical site infection (vancomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.6 Comparison 2 Sensitivity analysis, Outcome 6 Surgical site infection (vancomycin and cefazolin versus cefazolin).
6.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Surgical site infection (daptomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.7 Comparison 2 Sensitivity analysis, Outcome 7 Surgical site infection (daptomycin and cefazolin versus cefazolin).
7.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Surgical site infection (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.8 Comparison 2 Sensitivity analysis, Outcome 8 Surgical site infection (vancomycin versus cefuroxime).
8.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 MRSA surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.9 Comparison 2 Sensitivity analysis, Outcome 9 MRSA surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam).
9.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 MRSA surgical site infection (vancomycin versus teicoplanin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.10 Comparison 2 Sensitivity analysis, Outcome 10 MRSA surgical site infection (vancomycin versus teicoplanin).
10.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 MRSA surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.11 Comparison 2 Sensitivity analysis, Outcome 11 MRSA surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin).
11.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 MRSA surgical site infection (vancomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.12 Comparison 2 Sensitivity analysis, Outcome 12 MRSA surgical site infection (vancomycin and cefazolin versus cefazolin).
12.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 MRSA surgical site infection (daptomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.13 Comparison 2 Sensitivity analysis, Outcome 13 MRSA surgical site infection (daptomycin and cefazolin versus cefazolin).
13.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 MRSA surgical site infection (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.14 Comparison 2 Sensitivity analysis, Outcome 14 MRSA surgical site infection (vancomycin versus cefuroxime).
14.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Overall MRSA infections (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected
Open in figure viewer Analysis 2.15 Comparison 2 Sensitivity analysis, Outcome 15 Overall MRSA infections (kanamycin, erythromycin and cefotiam versus cefotiam).
15.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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Analysis 1.1

Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 1 Mortality.

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Analysis 1.2

Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 2 Overall surgical site infection.

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Analysis 1.3

Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 3 MRSA surgical site infection.

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Analysis 1.4

Comparison 1 Comparison of different regimens of prophylactic antibiotics, Outcome 4 Overall MRSA infections.

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Analysis 2.1

Comparison 2 Sensitivity analysis, Outcome 1 Mortality (kanamycin, erythromycin and cefotiam versus cefotiam).

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Analysis 2.2

Comparison 2 Sensitivity analysis, Outcome 2 Mortality (vancomycin versus cefuroxime).

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Analysis 2.3

Comparison 2 Sensitivity analysis, Outcome 3 Surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam).

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Analysis 2.4

Comparison 2 Sensitivity analysis, Outcome 4 Surgical site infection (vancomycin versus teicoplanin).

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Analysis 2.5

Comparison 2 Sensitivity analysis, Outcome 5 Surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin).

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Analysis 2.6

Comparison 2 Sensitivity analysis, Outcome 6 Surgical site infection (vancomycin and cefazolin versus cefazolin).

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Analysis 2.7

Comparison 2 Sensitivity analysis, Outcome 7 Surgical site infection (daptomycin and cefazolin versus cefazolin).

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Analysis 2.8

Comparison 2 Sensitivity analysis, Outcome 8 Surgical site infection (vancomycin versus cefuroxime).

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Analysis 2.9

Comparison 2 Sensitivity analysis, Outcome 9 MRSA surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam).

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Analysis 2.10

Comparison 2 Sensitivity analysis, Outcome 10 MRSA surgical site infection (vancomycin versus teicoplanin).

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Analysis 2.11

Comparison 2 Sensitivity analysis, Outcome 11 MRSA surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin).

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Analysis 2.12

Comparison 2 Sensitivity analysis, Outcome 12 MRSA surgical site infection (vancomycin and cefazolin versus cefazolin).

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Analysis 2.13

Comparison 2 Sensitivity analysis, Outcome 13 MRSA surgical site infection (daptomycin and cefazolin versus cefazolin).

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Analysis 2.14

Comparison 2 Sensitivity analysis, Outcome 14 MRSA surgical site infection (vancomycin versus cefuroxime).

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Analysis 2.15

Comparison 2 Sensitivity analysis, Outcome 15 Overall MRSA infections (kanamycin, erythromycin and cefotiam versus cefotiam).

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Summary of findings for the main comparison. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: mortality

Mortality
Patient or population: surgical patients Settings: secondary Intervention: comparison of different regimens of prophylactic antibiotic regimens
Comparisons	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Comparison of different regimens of prophylactic antibiotic regimens
One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol (elective surgery for colon cancer)	See comment	See comment	Not estimable	275 (1 study)	⊕⊝⊝⊝ very low^1,2
Kanamycin, erythromycin and cefotiam versus cefotiam (surgery for colorectal diseases)	See comment	See comment	Not estimable	143 (1 study)	⊕⊝⊝⊝ very low^1,2
Co‐amoxiclav or cefotaxime versus placebo (percutaneous endoscopic gastrostomy)	146 per 1000	79 per 1000 (25 to 251)	RR 0.54 (0.17 to 1.72)	99 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin versus cefuroxime (coronary artery bypass graft without valvular disease)	2 per 1000	5 per 1000 (0 to 50)	RR 2.02 (0.18 to 22.18)	884 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* is the control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence: High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ The risk of bias in the trial was high ² The confidence intervals overlapped 1 and/or 0.75 and 1.25. There were fewer than 300 events in total in the intervention and control groups

Summary of findings for the main comparison. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: mortality

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Summary of findings 2. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: surgical site infection

Surgical site infection
Patient or population: surgical patients Settings: secondary Intervention: comparison of different regimens of prophylactic antibiotic regimens
Comparisons	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Comparison of different regimens of prophylactic antibiotic regimens
Cefamendole versus cefamendole and gentamycin (median sternotomy)	Moderate		RR 5.08 (0.24 to 105.24)	522 (1 study)	⊕⊝⊝⊝ very low^1,2
	5 per 1000	25 per 1000 (1 to 526)	RR 5.08 (0.24 to 105.24)	522 (1 study)	⊕⊝⊝⊝ very low^1,2
Cefazolin versus cefamendole (median sternotomy)	8 per 1000	27 per 1000 (6 to 131)	RR 3.55 (0.75 to 16.95)	514 (1 study)	⊕⊝⊝⊝ very low^1,2
Cefazolin versus cefazolin and gentamycin (median sternotomy)	32 per 1000	28 per 1000 (10 to 75)	RR 0.87 (0.32 to 2.36)	508 (1 study)	⊕⊝⊝⊝ very low^1,2
Co‐amoxiclav or cefotaxime versus placebo (percutaneous endoscopic gastrostomy)	375 per 1000	98 per 1000 (41 to 244)	RR 0.26 (0.11 to 0.65)	99 (1 study)	⊕⊕⊝⊝ low¹
Daptomycin and cefazolin versus cefazolin (vascular surgery)	129 per 1000	39 per 1000 (9 to 177)	RR 0.3 (0.07 to 1.37)	113 (1 study)	⊕⊝⊝⊝ very low^1,2
Kanamycin, erythromycin and cefotiam versus cefotiam (surgery for colorectal diseases)	239 per 1000	110 per 1000 (50 to 242)	RR 0.46 (0.21 to 1.01)	143 (1 study)	⊕⊝⊝⊝ very low^1,2
Levofloxacin versus ofloxacin (breast cancer)	61 per 1000	40 per 1000 (11 to 146)	RR 0.66 (0.18 to 2.39)	181 (1 study)	⊕⊝⊝⊝ very low^1,2
One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam (elective colorectal surgery)	54 per 1000	57 per 1000 (28 to 116)	RR 1.06 (0.52 to 2.15)	521 (1 study)	⊕⊝⊝⊝ very low^1,2
One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol (elective surgery for colon cancer)	65 per 1000	51 per 1000 (19 to 134)	RR 0.79 (0.3 to 2.07)	275 (1 study)	⊕⊝⊝⊝ very low^1,2
Pefloxacin versus cefazolin and oxacillin (tibial fracture requiring external fixation)	90 per 1000	67 per 1000 (39 to 115)	RR 0.74 (0.43 to 1.28)	616 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin and cefazolin versus cefazolin (open fractures)	87 per 1000	87 per 1000 (23 to 327)	RR 1 (0.27 to 3.76)	92 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin and cefazolin versus cefazolin (vascular surgery) ‐ suggest add for all comparisons	129 per 1000	125 per 1000 (49 to 323)	RR 0.97 (0.38 to 2.5)	118 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin and cefazolin versus daptomycin and cefazolin (vascular surgery)	39 per 1000	125 per 1000 (27 to 575)	RR 3.19 (0.69 to 14.65)	107 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin versus teicoplanin (paediatric cardiac surgery)	No infection in either group		Not estimable	22 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin versus cefuroxime (coronary artery bypass graft without valvular disease)	32 per 1000	34 per 1000 (17 to 70)	RR 1.08 (0.53 to 2.21)	884 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* is the control group risk in the study. When there were no events in either group, we have indicated so. When there were events in the intervention group but not in the control group, we have used a moderate proportion of 0.5% in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence: High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ The risk of bias in the trial was high ² The confidence intervals overlapped 1 and/or 0.75 and 1.25. There were fewer than 300 events in total in the intervention and control groups

Summary of findings 2. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: surgical site infection

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Summary of findings 3. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: MRSA surgical site infection

MRSA surgical site infection
Patient or population: surgical patients Settings: secondary Intervention: comparison of different regimens of prophylactic antibiotic regimens
Comparisons	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Comparison of different regimens of prophylactic antibiotic regimens
Cefamendole versus cefamendole and gentamycin (median sternotomy)	No infection in either group		Not estimable	522 (1 study)	⊕⊝⊝⊝ very low^1,2
Cefazolin and gentamycin versus cefamendole and gentamycin (median sternotomy)	No infection in either group		Not estimable	516 (1 study)	⊕⊝⊝⊝ very low^1,2
Cefazolin versus cefamendole (median sternotomy)	Moderate		RR 3.05 (0.12 to 74.45)	514 (1 study)	⊕⊝⊝⊝ very low^1,2
	5 per 1000	15 per 1000 (1 to 372)
Cefazolin versus cefazolin and gentamycin (median sternotomy)	Moderate		RR 2.98 (0.12 to 72.72)	508 (1 study)	⊕⊝⊝⊝ very low^1,2
	5 per 1000	15 per 1000 (1 to 364)
Co‐amoxiclav or cefotaxime versus placebo (percutaneous endoscopic gastrostomy)	188 per 1000	9 per 1000 (0 to 156)	RR 0.05 (0 to 0.83)	99 (1 study)	⊕⊕⊝⊝ low¹
Daptomycin and cefazolin versus cefazolin (vascular surgery)	32 per 1000	8 per 1000 (0 to 159)	RR 0.24 (0.01 to 4.94)	113 (1 study)	⊕⊝⊝⊝ very low^1,2
Ertapenem versus cefotetan (elective colorectal surgery)	15 per 1000	9 per 1000 (2 to 37)	RR 0.59 (0.14 to 2.46)	672 (1 study)	⊕⊝⊝⊝ very low^1,2
Kanamycin, erythromycin and cefotiam versus cefotiam (surgery for colorectal diseases)	28 per 1000	55 per 1000 (10 to 294)	RR 1.97 (0.37 to 10.43)	143 (1 study)	⊕⊝⊝⊝ very low^1,2
Levofloxacin versus ofloxacin (breast cancer)	No infection in either group		Not estimable	181 (1 study)	⊕⊝⊝⊝ very low^1,2
One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam (elective colorectal surgery)	No infection in either group		Not estimable	521 (1 study)	⊕⊝⊝⊝ very low^1,2
One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol (elective surgery for colon cancer)	22 per 1000	22 per 1000 (5 to 107)	RR 1.02 (0.21 to 4.98)	275 (1 study)	⊕⊝⊝⊝ very low^1,2
Pefloxacin versus cefazolin and oxacillin (tibial fracture requiring external fixation)	3 per 1000	13 per 1000 (1 to 113)	RR 3.8 (0.43 to 33.78)	616 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin and cefazolin versus cefazolin (open fractures)	Moderate		RR 3 (0.13 to 71.78)	92 (1 study)	⊕⊝⊝⊝ very low^1,2
	5 per 1000	15 per 1000 (1 to 359)
Vancomycin and cefazolin versus cefazolin (vascular surgery)	32 per 1000	71 per 1000 (14 to 375)	RR 2.21 (0.42 to 11.63)	118 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin and cefazolin versus daptomycin and cefazolin (vascular surgery)	Moderate		RR 8.21 (0.45 to 148.84)	107 (1 study)	⊕⊝⊝⊝ very low^1,2
	5 per 1000	41 per 1000 (2 to 744)
Vancomycin versus teicoplanin (paediatric cardiac surgery)	No infection in either group		Not estimable	22 (1 study)	⊕⊝⊝⊝ very low^1,2
Vancomycin versus cefuroxime (coronary artery bypass graft without valvular disease)	5 per 1000	5 per 1000 (1 to 32)	RR 1.01 (0.14 to 7.13)	884 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* is the control group risk in the study. When there were no events in either group, we have indicated so. When there were events in the intervention group but not in the control group, we have used a moderate proportion of 0.5% in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence: High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ The risk of bias in the trial was high ² The confidence intervals overlapped 1 and/or 0.75 and 1.25. There were fewer than 300 events in total in the intervention and control groups

Summary of findings 3. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: MRSA surgical site infection

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Summary of findings 4. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: overall MRSA infections

Overall MRSA infections
Patient or population: surgical patients Settings: secondary Intervention: comparison of different regimens of prophylactic antibiotic regimens
Comparisons	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)
	Assumed risk	Corresponding risk
	Control	Comparison of different regimens of prophylactic antibiotic regimens
One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol (elective surgery for colon cancer)	29 per 1000	22 per 1000 (5 to 97)	RR 0.77 (0.17 to 3.36)	275 (1 study)	⊕⊝⊝⊝ very low^1,2
Kanamycin, erythromycin and cefotiam versus cefotiam (surgery for colorectal diseases)	56 per 1000	111 per 1000 (35 to 353)	RR 1.97 (0.62 to 6.26)	143 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* is the control group risk in the study. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence: High quality: further research is very unlikely to change our confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: we are very uncertain about the estimate
¹ The risk of bias in the trial was high. ² The confidence intervals overlapped 1 and/or 0.75 and 1.25. There were fewer than 300 events in total in the intervention and control groups.

Summary of findings 4. Antibiotic prophylaxis for the prevention of methicillin‐resistant Staphylococcus aureus (MRSA) infections and related complications in surgical patients: overall MRSA infections

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Comparison 1. Comparison of different regimens of prophylactic antibiotics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Overall surgical site infection Show forest plot	11		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Cefamendole versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Cefazolin and gentamycin versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Cefazolin versus cefamendole	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Cefazolin versus cefazolin and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.5 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.6 Daptomycin and cefazolin versus cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.7 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.8 Levofloxacin versus ofloxacin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.9 One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.10 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.11 Pefloxacin versus cefazolin and oxacillin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.12 Vancomycin and cefazolin versus cefazolin (open fractures)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.13 Vancomycin and cefazolin versus cefazolin (vascular surgery)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.14 Vancomycin and cefazolin versus daptomycin and cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.15 Vancomycin versus teicoplanin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.16 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 MRSA surgical site infection Show forest plot	12		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3.1 Cefamendole versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Cefazolin and gentamycin versus cefamendole and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Cefazolin versus cefamendole	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Cefazolin versus cefazolin and gentamycin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.5 Co‐amoxiclav or cefotaxime versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.6 Daptomycin and cefazolin versus cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.7 Ertapenem versus cefotetan	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.8 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.9 Levofloxacin versus ofloxacin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.10 One day of piperacillin, cefazolin, cefmetazole, or cefotiam versus three days of piperacillin, cefazolin, cefmetazole, or cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.11 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.12 Pefloxacin versus cefazolin and oxacillin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.13 Vancomycin and cefazolin versus cefazolin (open fractures)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.14 Vancomycin and cefazolin versus cefazolin (vascular surgery)	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.15 Vancomycin and cefazolin versus daptomycin and cefazolin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.16 Vancomycin versus teicoplanin	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.17 Vancomycin versus cefuroxime	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Overall MRSA infections Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 One dose of cefotiam or cefmetazol versus four doses of cefotiam or cefmetazol	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Kanamycin, erythromycin and cefotiam versus cefotiam	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Comparison of different regimens of prophylactic antibiotics

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Comparison 2. Sensitivity analysis

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Mortality (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Surgical site infection (vancomycin versus teicoplanin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

4.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

5.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Surgical site infection (vancomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

6.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Surgical site infection (daptomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

7.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Surgical site infection (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

8.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 MRSA surgical site infection (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

9.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
9.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10 MRSA surgical site infection (vancomycin versus teicoplanin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

10.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
10.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11 MRSA surgical site infection (vancomycin and cefazolin versus daptomycin and cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

11.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
11.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12 MRSA surgical site infection (vancomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

12.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
12.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13 MRSA surgical site infection (daptomycin and cefazolin versus cefazolin) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

13.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
13.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14 MRSA surgical site infection (vancomycin versus cefuroxime) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

14.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
14.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15 Overall MRSA infections (kanamycin, erythromycin and cefotiam versus cefotiam) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

15.1 Best‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.2 Worst‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.3 Best‐worst scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
15.4 Worst‐best scenario	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Sensitivity analysis

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Referencias

References to studies included in this review

Carsenti‐Etesse 1999 {published data only}

Goldstein 2009 {published data only}

Hashizume 2004 {published data only}

Ishibashi 2009 {published data only}

Ishida 2001 {published data only}

Kaiser 1987 {published data only}

Morimoto 2002 {published data only}

Saadeddin 2005 {published data only}

Saveli 2011 {published data only}

Shime 2007 {published data only}

Stone 2010 {published data only}

Vuorisalo 1998 {published data only}

References to studies excluded from this review

Al‐Mukhtar 2009 {published data only}

Bluhm 1984 {published data only}

Cann 1988 {published data only}

Dhadwal 2007 {published data only}

Diehr 2007 {published data only}

Finkelstein 2002 {published data only}

Frimodt‐Moller 1982 {published data only}

Kanellakopoulou 2009 {published data only}

Kato 2006 {published data only}

Keighley 1979 {published data only}

Maki 1992 {published data only}

Marroni 1999 {published data only}

Mindermann 1993 {published data only}

Palmer 1995 {published data only}

Poon 1998 {published data only}

Ramos 2008 {published data only}

Saginur 2000 {published data only}

Salminen 1999 {published data only}

Tacconelli 2008 {published data only}

Tyllianakis 2010 {published data only}

Weaver 1986 {published data only}

Wilson 1988 {published data only}

Additional references

Alou 2004

Barber 1961

Boyce 1994

Cantoni 1989

Chambers 2010

Chemaly 2010

Chua 2008

Cowie 2005

Creamer 2011

DeMets 1987

DerSimonian 1986

ECDC 2009a

ECDC 2009b

Egger 1997

Fraser 2010

Garner 1986

Gurusamy

Gurusamy 2009

Harbarth 2008a

Harbarth 2008b

Higgins 2002

Higgins 2011a

Higgins 2011b

Higgins 2011c

Horan 1992

ICH‐GCP 1996

Jevons 1961

Kallen 2010

Kang 2012

Kaye 2008

Kjaergard 2001

Klimek 1976

Knox 1961

Kuehnert 2005

Lamagni 2011

Lefebvre 2011

Lewis 2011

Liu 2011

Loeb 2003

Macaskill 2001