Abstract
Background To investigate if perioperative parenteral administration of
fosfomycin given before or during gastrointestinal surgery could protect against
postoperative infectious complications and characterise the administration of
fosfomycin and its harms.
Methods This systematic review included original studies on
gastrointestinal surgery where parental administration of fosfomycin was given
before or during surgery to≥5 patients. We searched three databases on
March 24 2023 and registered the protocol before data extraction
(CRD42020201268). Risk of bias was assessed with Cochrane Handbook risk of bias
assessment tool or the Newcastle-Ottawa Scale. A narrative description was
undertaken. For infectious complications, results from emergency and elective
surgery were presented separately.
Results We included 15 unique studies, reporting on 1,029 patients that
received fosfomycin before or during gastrointestinal surgery. Almost half of
the studies were conducted in the 1980s to early 1990s, and typically a dose of
4 g fosfomycin was given before surgery co-administered with metronidazole and
often repeated postoperatively. The risk of bias across studies was moderate to
high. The rates of infectious complications were low after fosfomycin; the
surgical site infection rate was 0–1% in emergency surgery and
0–10% in elective surgery. If reported, harms were few and mild
and typically related to the gastrointestinal system.
Conclusion There were few postoperative infectious complications after
perioperative parenteral administration of one or more doses of 4 g fosfomycin
supplemented with metronidazole in various gastrointestinal procedures.
Fosfomycin was associated with few and mild harms.
Keywords
fosfomycin - gastrointestinal surgical procedure - systematic review - postoperative complications - adverse effects
