Michael R Whitehouse1,2, Catriona McDaid3, Michael B Kelly2, Christopher G Moran4, Matthew L Costa5. 1. Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. 2. Department of Trauma and Orthopaedics, Avon Orthopaedic Centre, Bristol, UK. 3. York Trials Unit, Department of Health Sciences, University of York, York, UK. 4. Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK. 5. Oxford Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
Abstract
OBJECTIVE: To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes. DESIGN: We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. DATA SOURCES: We searched five electronic databases with no limits and performed grey literature searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included. RESULTS: Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rate ranged from 5% to 17.5%. All of the studies were at substantial risk of bias. One study reported a reduced infection rate with the delivery of antibiotics within 66 min of injury and seven studies reporting no effect. CONCLUSIONS: Sufficiently robust evidence is not available currently to determine whether the timing of delivery of intravenous antibiotics has an effect on the risk of deep infection or other outcomes following open limb fractures. There is therefore a need for a randomised controlled trial in this area before policy changes should be instigated. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42015016729). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes. DESIGN: We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies. DATA SOURCES: We searched five electronic databases with no limits and performed grey literature searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included. RESULTS: Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rate ranged from 5% to 17.5%. All of the studies were at substantial risk of bias. One study reported a reduced infection rate with the delivery of antibiotics within 66 min of injury and seven studies reporting no effect. CONCLUSIONS: Sufficiently robust evidence is not available currently to determine whether the timing of delivery of intravenous antibiotics has an effect on the risk of deep infection or other outcomes following open limb fractures. There is therefore a need for a randomised controlled trial in this area before policy changes should be instigated. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42015016729). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
fractures and dislocations; wounds; wounds, infection
Authors: James K-K Chan; Alexander L Aquilina; Sharon R Lewis; Jeremy N Rodrigues; Xavier L Griffin; Jagdeep Nanchahal Journal: Cochrane Database Syst Rev Date: 2022-04-01
Authors: M Morgenstern; A Vallejo; M A McNally; T F Moriarty; J Y Ferguson; S Nijs; W J Metsemakers Journal: Bone Joint Res Date: 2018-08-04 Impact factor: 5.853