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The effect of local antibiotic prophylaxis when treating open limb fractures
Journal article

The effect of local antibiotic prophylaxis when treating open limb fractures

  • Morgenstern, M. Department of Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland
  • Vallejo, A. Orthopaedic and Traumatology Department, Clinica Leon Trece, Universidad Pontificia Bolivariana, Medellin, Columbia and AO Research Institute, Davos, Switzerland
  • McNally, M. A. Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
  • Moriarty, T. F. AO Research Institute Davos, Davos, Switzerland
  • Ferguson, J. Y. Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, UK
  • Nijs, S. Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium and Associate Professor, Faculty of Medicine, KU Leuven, University of Leuven, Leuven, Belgium
  • Metsemakers, WJ. Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium and Associate Professor, Faculty of Medicine, KU Leuven, University of Leuven, Leuven, Belgium
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Published in:
  • Bone & Joint Research. - British Editorial Society of Bone & Joint Surgery. - 2018, vol. 7, no. 7, p. 447-456
English ObjectivesAs well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures.MethodsA comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis.ResultsIn total, eight studies which included 2738 patients were eligible for quantitative synthesis. The effect of antibiotic-loaded poly(methyl methacrylate) beads was investigated by six of these studies, and two studies evaluated the effect of local antibiotics applied without a carrier. Meta-analysis showed a significantly lower infection rate when local antibiotics were applied (4.6%; 91/1986) than in the control group receiving standard systemic prophylaxis alone (16.5%; 124/752) (p < 0.001) (odds ratio 0.30; 95% confidence interval 0.22 to 0.40).ConclusionThis meta-analysis suggests a risk reduction in FRI of 11.9% if additional local antibiotics are given prophylactically for open limb fractures. However, due to limited quality, heterogeneity, and considerable risk of bias, the pooling of data from primary studies has to be interpreted with caution. Cite this article: M. Morgenstern, A. Vallejo, M. A. McNally, T. F. Moriarty, J. Y. Ferguson, S. Nijs, WJ. Metsemakers. Bone Joint Res 2018;7:447–456. The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis. DOI: 10.1302/2046-3758.77.BJR-2018-0043.R1
Language
  • English
Open access status
gold
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https://sonar.ch/global/documents/201656
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