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Meta-Analysis
. 2010 Mar 17;2010(3):CD000244.
doi: 10.1002/14651858.CD000244.pub2.

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures

William J Gillespie  1 , Geert Him Walenkamp
Affiliations
Meta-Analysis

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures

William J Gillespie et al. Cochrane Database Syst Rev. .

Abstract

Background: Surgical site infection and other hospital-acquired infections cause significant morbidity after internal fixation of fractures. The administration of antibiotics may reduce the frequency of infections.

Objectives: To determine whether the prophylactic administration of antibiotics in people undergoing surgical management of hip or other closed long bone fractures reduces the incidence of surgical site and other hospital-acquired infections.

Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE (1950 to November 2009), EMBASE (1988 to December 2009), other electronic databases including the WHO International Clinical Trials Registry Platform (December 2009), conferences proceedings and reference lists of articles.

Selection criteria: Randomised or quasi-randomised controlled trials comparing any regimen of systemic antibiotic prophylaxis administered at the time of surgery, compared with no prophylaxis, placebo, or a regimen of different duration, in people with a hip fracture undergoing surgery for internal fixation or prosthetic replacement, or with any closed long bone fracture undergoing internal fixation. All trials needed to report surgical site infection.

Data collection and analysis: Two authors independently screened papers for inclusion, assessed risk of bias and extracted data. Pooled data are presented graphically.

Main results: Data from 8447 participants in 23 studies were included in the analyses. In people undergoing surgery for closed fracture fixation, single dose antibiotic prophylaxis significantly reduced deep surgical site infection (risk ratio 0.40, 95% CI 0.24 to 0.67), superficial surgical site infections, urinary infections, and respiratory tract infections. Multiple dose prophylaxis had an effect of similar size on deep surgical site infection (risk ratio 0.35, 95% CI 0.19 to 0.62), but significant effects on urinary and respiratory infections were not confirmed. Although the risk of bias in many studies as reported was unclear, sensitivity analysis showed that removal from the meta-analyses of studies at high risk of bias did not alter the conclusions. Economic modelling using data from one large trial indicated that single dose prophylaxis with ceftriaxone is a cost-effective intervention. Data for the incidence of adverse effects were very limited, but as expected they appeared to be more common in those receiving antibiotics, compared with placebo or no prophylaxis.

Authors' conclusions: Antibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Antibiotic agent (multiple dose) versus placebo or no treatment, Outcome 1 Deep surgical site infection.
1.2
1.2. Analysis
Comparison 1 Antibiotic agent (multiple dose) versus placebo or no treatment, Outcome 2 Superficial surgical site infection.
1.3
1.3. Analysis
Comparison 1 Antibiotic agent (multiple dose) versus placebo or no treatment, Outcome 3 Urinary tract infection.
1.4
1.4. Analysis
Comparison 1 Antibiotic agent (multiple dose) versus placebo or no treatment, Outcome 4 Respiratory infection.
2.1
2.1. Analysis
Comparison 2 Antibiotic agent (single dose) versus placebo or no treatment, Outcome 1 Deep surgical site infection.
2.2
2.2. Analysis
Comparison 2 Antibiotic agent (single dose) versus placebo or no treatment, Outcome 2 Superficial surgical site infection.
2.3
2.3. Analysis
Comparison 2 Antibiotic agent (single dose) versus placebo or no treatment, Outcome 3 Urinary tract infection.
2.4
2.4. Analysis
Comparison 2 Antibiotic agent (single dose) versus placebo or no treatment, Outcome 4 Respiratory infection.
3.1
3.1. Analysis
Comparison 3 Single dose short‐acting versus multiple dose ‐ same agent, Outcome 1 Deep surgical site infection.
3.2
3.2. Analysis
Comparison 3 Single dose short‐acting versus multiple dose ‐ same agent, Outcome 2 Superficial surgical site infection.
3.3
3.3. Analysis
Comparison 3 Single dose short‐acting versus multiple dose ‐ same agent, Outcome 3 Urinary tract infection.
4.1
4.1. Analysis
Comparison 4 Single dose long acting versus any multiple dose regimen, Outcome 1 Deep wound infection.
4.2
4.2. Analysis
Comparison 4 Single dose long acting versus any multiple dose regimen, Outcome 2 Superficial wound infection.
4.3
4.3. Analysis
Comparison 4 Single dose long acting versus any multiple dose regimen, Outcome 3 Urinary tract infection.
4.4
4.4. Analysis
Comparison 4 Single dose long acting versus any multiple dose regimen, Outcome 4 Respiratory infection.
5.1
5.1. Analysis
Comparison 5 Operative day only versus longer prophylaxis, Outcome 1 Deep surgical site infection.
5.2
5.2. Analysis
Comparison 5 Operative day only versus longer prophylaxis, Outcome 2 Superficial surgical site infection.
6.1
6.1. Analysis
Comparison 6 Oral versus parenteral administration of antibiotic agent, Outcome 1 Deep surgical site infection.
6.2
6.2. Analysis
Comparison 6 Oral versus parenteral administration of antibiotic agent, Outcome 2 Superficial surgical site infection.
6.3
6.3. Analysis
Comparison 6 Oral versus parenteral administration of antibiotic agent, Outcome 3 Urinary tract infection.
7.1
7.1. Analysis
Comparison 7 Antibiotic agent versus control or no treatment (infection‐related death and adverse drug events), Outcome 1 Surgical site infection‐associated death.
7.2
7.2. Analysis
Comparison 7 Antibiotic agent versus control or no treatment (infection‐related death and adverse drug events), Outcome 2 Gastro‐intestinal symptoms.
7.3
7.3. Analysis
Comparison 7 Antibiotic agent versus control or no treatment (infection‐related death and adverse drug events), Outcome 3 Skin reactions.
7.4
7.4. Analysis
Comparison 7 Antibiotic agent versus control or no treatment (infection‐related death and adverse drug events), Outcome 4 Infusion site thrombophlebitis.
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References

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References to ongoing studies

ISRCTN75423827 {published data only}
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