Yaping Chang1, Mohit Bhandari1, Kan Lun Zhu1, Reza Donald Mirza1, Melody Ren2, Sean Alexander Kennedy2, Ahmed Negm1, Neera Bhatnagar1, Faysal N Naji1, Lazar Milovanovic3, Yutong Fei4, Arnav Agarwal2, Rakhshan Kamran1, Sung Min Cho2, Stefan Schandelmaier1,5, Li Wang1, Lin Jin1, Shiyun Hu6, Yanping Zhao7, Luciane Cruz Lopes8, Mei Wang1, Brad Petrisor1, Bill Ristevski1, Reed A C Siemieniuk1, Gordon H Guyatt1. 1. Department of Health Research Methods, Evidence, and Impact (Y.C., M.B., R.K., S.S., L.J., M.W., R.A.C.S., and G.H.G.), Division of Orthopedic Surgery, Department of Surgery (M.B., B.P., and B.R.), School of Rehabilitation Science (A.N.), Department of Medicine (K.L.Z., R.D.M., and G.H.G.), Health Science Library (N.B.), Division of Vascular Surgery (F.N.N.), Department of Anesthesia (L.W.), and Michael G. DeGroote Institute for Pain Research and Care (L.W.), McMaster University, Hamilton, Ontario, Canada. 2. Faculty of Medicine (M.R., A.A., and S.M.C.), and Department of Diagnostic Radiology (S.A.K.), University of Toronto, Toronto, Ontario, Canada. 3. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 4. Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China. 5. Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland. 6. Cardiovascular and Cerebrovascular Disease Prevention and Control Research Center of Zhejiang Province, Zhejiang Hospital, Hangzhou, Zhejiang, China. 7. School of Public Health, The University of Hong Kong, Hong Kong, China. 8. Pharmaceutical Sciences Postgraduate Course, University of Sorocaba (UNISO), Sorocaba, Sao Paulo, Brazil.
Abstract
BACKGROUND: Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing current practice and recommendations. METHODS: We included publications from January 2007 to June 2017. We searched Embase, MEDLINE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews for clinical studies and surveys of surgeons; WorldCat for textbooks; and web sites for guidelines and institutional protocols. RESULTS: We identified 223 eligible publications that reported 100 clinical practice patterns and 276 recommendations with regard to systemic antibiotic administration, and 3 recommendations regarding local antibiotic administration alone. Most publications of clinical practice patterns used regimens with both gram-positive and gram-negative coverage and continued the administration for 2 to 3 days. Most publications recommended prophylactic systemic antibiotics. Most recommendations suggested gram-positive coverage for less severe injuries and administration duration of 3 days or less. For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Most publications reported intravenous administration of antibiotics immediately. CONCLUSIONS: Current practice and recommendations strongly support early systemic antibiotic prophylaxis for patients with open fractures of the extremities. Differences in antibiotic regimens, doses, and durations of administration remain in both practice and recommendations. Consensus with regard to optimal practice will likely require well-designed randomized controlled trials. CLINICAL RELEVANCE: The current survey of literature systematically provides surgeons' practice and the available expert recommendations from 2007 to 2017 on the use of prophylactic antibiotics in the management of open fractures of extremities.
BACKGROUND: Evidence with regard to antibiotic prophylaxis for patients with open fractures of the extremities is limited. We therefore conducted a systematic survey addressing current practice and recommendations. METHODS: We included publications from January 2007 to June 2017. We searched Embase, MEDLINE, CINAHL, the Cochrane Central Registry of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews for clinical studies and surveys of surgeons; WorldCat for textbooks; and web sites for guidelines and institutional protocols. RESULTS: We identified 223 eligible publications that reported 100 clinical practice patterns and 276 recommendations with regard to systemic antibiotic administration, and 3 recommendations regarding local antibiotic administration alone. Most publications of clinical practice patterns used regimens with both gram-positive and gram-negative coverage and continued the administration for 2 to 3 days. Most publications recommended prophylactic systemic antibiotics. Most recommendations suggested gram-positive coverage for less severe injuries and administration duration of 3 days or less. For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Most publications reported intravenous administration of antibiotics immediately. CONCLUSIONS: Current practice and recommendations strongly support early systemic antibiotic prophylaxis for patients with open fractures of the extremities. Differences in antibiotic regimens, doses, and durations of administration remain in both practice and recommendations. Consensus with regard to optimal practice will likely require well-designed randomized controlled trials. CLINICAL RELEVANCE: The current survey of literature systematically provides surgeons' practice and the available expert recommendations from 2007 to 2017 on the use of prophylactic antibiotics in the management of open fractures of extremities.
Authors: Lisa G M Friedman; Terri A Zachos; Daniela Sanchez; Akhil Tawari; Harish Kempegowda; Scott Ryan; Anna Michalowski; Daniel S Horwitz Journal: Eur J Orthop Surg Traumatol Date: 2022-01-15
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