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Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fracturesGillespie WJ, Walenkamp G
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SummaryAntibiotic prophylaxis for surgery for proximal femoral and other closed long bone fracturesWound infection and other hospital acquired infections can be life threatening in people following surgery for thigh and other long bone fractures. Antibiotics have been given routinely since the 1970s in an effort to reduce infections from bacteria such as staphylococcus. The review of trials found that antibiotics are effective in reducing the incidence of infection, both at the wound site and in the chest and urine. The effect of a single dose is similar to those from multi-doses if the antibiotic chosen is active through the period from the beginning to the end of surgery.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 26. 1998 AbstractBackgroundWound infection and other hospital-acquired infections cause significant morbidity after internal fixation of fractures (osteosynthesis). The administration of antimicrobial agents (antibiotics) may reduce the frequency of infections. ObjectivesTo determine whether the prophylactic administration of antibiotics in patients undergoing surgical management of hip or other long bone fractures reduces the incidence of wound and other hospital acquired infections. Search strategyWe searched the The Cochrane Library, Issue 3 2000; MEDLINE, EMBASE, LILACS, Current Contents, Dissertation Abstracts, and Index to UK Theses to August 2000. Bibliographies of identified articles were screened for further relevant trials. No language restriction was applied. Selection criteriaRandomised or quasi-randomised controlled trials involving - Data collection and analysisTwo reviewers independently screened papers for inclusion, assessed trial quality using an eight item scale, and extracted data. Additional information was sought from two trialists. Pooled data are presented graphically. Main resultsData from 8307 participants in 22 studies were analysed. In patients undergoing surgery for closed fracture fixation, single dose antibiotic prophylaxis significantly reduced deep wound infection (risk ratio 0.40, 95% CI 0.24 to 0.67) superficial wound infections, urinary infections, and respiratory tract infections. Multiple dose prophylaxis had an effect of similar size on deep wound infection (risk ratio 0.40, 95% CI 0.24 to 0.67), but significant effects on urinary and respiratory infections were not confirmed. Economic modelling using data from one large trial indicates that single dose prophylaxis with ceftriaxone is a cost-effective intervention. There are limited data for the incidence of adverse effects, but as expected they appear to be more common in those receiving antibiotics, compared with placebo or no prophylaxis. Authors' conclusionsAntibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation. |