Studies that compared the effect of any antibiotic or combined antibiotics with no prophylactic antibiotic or placebo were eligible. Participants had to undergo transarterial procedure for hepatocellular carcinoma. Randomised and non-randomised studies were included if they had a control group.
The primary outcome of interest was any proven systemic infection such as bacteraemia, septicaemia and sepsis, hepatic abscess and other clinical indications of infection. Secondary outcomes included suspected infection or clinical signs of infection (such as fever, elevated white blood cell count or C-reactive protein level) and duration of hospital stay.
Where reported, patients' mean/median age was approximately 60 years old. Where reported, most participants were male and had either hepatitis B or C; most had multiple tumour lesions. Where reported, most patients had a Child-Pugh score of A, and mean white blood cells count ranged from 4.8 to 7.3 x109/L.
Two of the studies used transarterial chemoembolisation, one used transarterial embolisation and one study used one of the two procedures or Yttrium-90. Intravenous cephalosporin alone or combined with metronidazole antibiotics were the most often used before transarterial therapy. Other treatments included ciprofloxacin as initial or maintenance therapy. Regimens varied among the studies. Depending on the antibiotics used, treatment lasted from half an hour to 10 days. Diagnosis of bacterial infection (biological fluid cultures) and hepatic abscesses (using computed tomography) were described in one study each. All treatments were compared to no treatment. Studies were conducted between 1992 and 2007 in Germany, Spain, the USA and China.
Two reviewers independently selected the studies. Disagreements were resolved by discussion.