Systematic review and meta-analysis shows cefotiam reduces postoperative infection in clean surgery

BACKGROUND: Postoperative infection (POI) is a common postoperative complication that leads to increased morbidity, antibiotic use, and prolonged hospitalization. Cefazolin is the standard prophylactic antibiotic for POI prevention, but its recent shortages highlight the need for alternative options. This study aimed to evaluate the effectiveness of cefotiam as a potential alternative for preventing POI. METHODS: This study conducted systematic review and meta-analysis using four medical electronic databases. Inclusion criteria were original research articles published up to June 25 in 2024, while non-original articles were excluded. Eligible participants included adults administered cefotiam in original research articles. A random-effects model was utilized to synthesize studies. RESULTS: Twenty-one randomized controlled trials (3497 patients) were included. Among these, 1753 patients received cefotiam (intervention group) while 1744 were assigned to the control group, including those receiving no antibiotic prophylaxis (811 patients) or other β-lactam agents (918 patients). Cefotiam prophylaxis significantly reduced the incidence of POI compared with no antibiotic prophylaxis, particular in clean surgical procedures (relative risk [RR] = 0.509; 95% confidence interval [CI]: 0.378-0.685; I = 0.0%), but showed no significant difference versus other β-lactam antibiotics (RR = 1.149; 95% CI: 0.878-1.502; I = 0.0%). No significant difference in adverse events was observed between groups (RR = 0.930; 95% CI: 0.330-2.624). No publication bias was detected. CONCLUSIONS: This systematic review and meta-analysis demonstrated that cefotiam is an effective alternative for POI prevention in clean surgical procedures. The use of cefotiam significantly reduced POI compared with no prophylaxis antibiotic administration without increasing adverse events.