Ninety RCTs were included in the review. Sixty-four studies assessed incisional surgical site infection (n=22,888 participants), 44 studies assessed urinary tract infection (n=14,907) and 38 studies assessed pneumonia (n=13,889). A Jadad score of at least 4 was achieved by 11 trials in the analysis of incisional surgical site infection, eight in the analysis of urinary tract infection and seven in the analysis of pneumonia.
Ceftriaxone was associated with a significant reduction in incisional surgical site infection compared with other antibiotics (OR 0.68, 95% CI 0.53 to 0.7; 61 RCTs). Significant benifit was observed for abdominal-gastrointestinal surgery, but there was no significant difference between the two groups for pelvic or clean surgery.
There was a significant reduction in urinary tract infection in the ceftriaxone group compared with other antibiotics (OR 0.52, 95% CI 0.43 to 0.63; 35 RCTs). The significant benefit was observed only for abdominal-gastrointestinal and pelvic surgery.
There was a significant reduction in pneumonia in the ceftriaxone group compared with other antibiotics (OR 0.66, 95% CI 0.54 to 0.81; 37 RCTs). The significant benefit was only observed for abdominal-gastrointestinal surgery.
No significant heterogeneity was observed for these outcomes. Sensitivity analyses did not materially alter the results. No evidence of publication bias was identified. Results for subgroup analyses of different types of comparator antibiotics were reported.