|
1
|
Chang Y, Kennedy SA, Bhandari M, Lopes LC, Bergamaschi CDC, Carolina de Oliveira E Silva M, Bhatnagar N, Mousavi SM, Khurshid S, Petrisor B, Ren M, Sodhi SK, Mirza RD, Guyatt GH. Effects of Antibiotic Prophylaxis in Patients with Open Fracture of the Extremities: A Systematic Review of Randomized Controlled Trials. JBJS Rev 2018; 3:01874474-201506000-00002. [PMID: 27490013 DOI: 10.2106/jbjs.rvw.n.00088] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The purpose of the present study was to perform a systematic review and meta-analysis of the use of alternative antibiotic regimens-including (A) antibiotic prophylaxis versus no prophylaxis, (B) longer versus shorter duration of antibiotic prophylaxis, and (C) alternative drugs-for patients with open fracture of the extremities. METHODS Data sources included CINAHL, EMBASE, MEDLINE, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane database of systematic reviews from 1965 to December 2013. All randomized controlled trials comparing the effectiveness of antibiotic prophylaxis in patients with open fracture of the extremities were eligible. RESULTS We identified 329 potentially eligible articles, of which seventeen proved to be eligible. In four randomized controlled trials involving 472 patients, we found a significantly lower infection rate in patients receiving antibiotic prophylaxis compared with those not receiving antibiotic prophylaxis (risk ratio = 0.37 [95% confidence interval, 0.21 to 0.66]; absolute risk reduction = 9.6% [95% confidence interval, 5.2% to 12.1%]). In three studies involving 1104 patients, we found no difference in the infection rate when a longer duration of antibiotics (three to five days) was compared with a shorter duration (one day) (risk ratio = 0.97; 95% confidence interval, 0.69 to 1.37). Confidence in the estimates for both questions was low to moderate. Individual comparisons of alternative drugs yielded estimates warranting only low to very low confidence. CONCLUSIONS Results of randomized controlled trials performed to date provide evidence that antibiotic prophylaxis reduces subsequent infection and that courses as short as one day are as effective as courses of three to five days, although the evidence warrants only low to moderate confidence. Given current practice, a large, multicenter, low risk of bias, randomized controlled trial enrolling representative populations and addressing the duration of antibiotics may be the next optimum step in investigation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Yaping Chang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Sean Alexander Kennedy
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Luciane Cruz Lopes
- Pharmaceutical Sciences Postgraduate Course, University of Sorocaba, UNISO, Rodovia Raposo Tavares, 18023-000 Sorocaba, Sao Paulo, Brazil
| | - Cristiane de Cássia Bergamaschi
- Pharmaceutical Sciences Postgraduate Course, University of Sorocaba, UNISO, Rodovia Raposo Tavares, 18023-000 Sorocaba, Sao Paulo, Brazil
| | - Maria Carolina de Oliveira E Silva
- Pharmaceutical Sciences Postgraduate Course, University of Sorocaba, UNISO, Rodovia Raposo Tavares, 18023-000 Sorocaba, Sao Paulo, Brazil
| | - Neera Bhatnagar
- Health Science Library, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - S Mohsen Mousavi
- asim, Swiss Academy of Insurance Medicine, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Saqib Khurshid
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Brad Petrisor
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Melody Ren
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Sukhmani K Sodhi
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Reza Donald Mirza
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| |
Collapse
|