Slobogean Gerard P, Kennedy Stephen A, Davidson Darin, O'Brien Peter J
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Orthop Trauma. 2008 Apr;22(4):264-9. doi: 10.1097/BOT.0b013e31816b7880.
The use of prophylactic antibiotics in the surgical treatment of closed long bone fractures is well established. The duration and dosage of prophylaxis, however, vary significantly among surgeons. A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infections during the treatment of closed long bone fractures.
Articles were identified by searching the following medical databases: Medline, Medline In Process & Other Non-indexed Citations, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews. Relevant conference proceedings and the reference section of selected manuscripts were also searched for additional studies.
Studies were included if they were prospective randomized controlled trials of patients with closed fractures treated with surgical fixation or arthroplasty. The interventions must have directly compared a single preoperative prophylactic dose to a multiple-dose perioperative strategy. Studies were excluded if they involved open fractures.
The demographic information, prophylaxis strategy, wound infection rate, and risk ratio were extracted from each article.
Seven trials and 3,808 patients were pooled using a random effects model. When compared to a regimen of multiple doses of prophylactic antibiotics, administration of a single preoperative dose has a risk ratio of 1.24 (95% CI 0.60-2.60). The pooled risk difference between the 2 strategies is 0.005 (95% CI -0.011-0.021). Neither result is significant.
In the setting of closed long bone fractures, the pooled results failed to demonstrate superiority of multiple-dose prophylaxis over a single-dose strategy. The pooled estimates suggest that surgical wound infections are relatively rare events and that any potential difference in infection rates between prophylaxis strategies is likely quite small. However, because the confidence interval surrounding the pooled risk ratio spans 1.0 by such a large amount, we are unable to definitively recommend a preferred dosing regimen to prevent surgical wound infections. Although future research is required to ensure our prophylaxis decisions continue to be evidence based and cost-effective, it is unlikely that a single clinical trial will be able to provide the answer. The use of other quantitative methods, such as cost-effectiveness analysis, may be helpful in modeling an optimal prophylaxis strategy.
预防性使用抗生素在闭合性长骨骨折手术治疗中已得到广泛应用。然而，不同外科医生在预防用药的持续时间和剂量上差异很大。进行了一项系统评价和荟萃分析，以确定在闭合性长骨骨折治疗中，围手术期多次剂量预防性使用抗生素是否比术前单次剂量更有效地预防手术伤口感染。
通过检索以下医学数据库来识别文章：Medline、Medline在研及其他未索引引文、Embase、CENTRAL和Cochrane系统评价数据库。还检索了相关会议论文集以及所选手稿的参考文献部分以寻找其他研究。
纳入的研究需为对接受手术固定或关节置换术治疗的闭合性骨折患者进行的前瞻性随机对照试验。干预措施必须直接比较术前单次预防性剂量与围手术期多次剂量策略。涉及开放性骨折的研究被排除。
从每篇文章中提取人口统计学信息、预防策略、伤口感染率和风险比。
使用随机效应模型汇总了7项试验和3808名患者的数据。与多次剂量预防性抗生素方案相比，术前单次给药的风险比为1.24（95%可信区间0.60 - 2.60）。两种策略之间汇总的风险差异为0.005（95%可信区间 - 0.011 - 0.021）。两个结果均无统计学意义。
在闭合性长骨骨折的情况下，汇总结果未能证明多次剂量预防优于单次剂量策略。汇总估计表明手术伤口感染是相对罕见的事件，并且预防策略之间感染率的任何潜在差异可能相当小。然而，由于汇总风险比周围的可信区间如此大幅度地跨越1.0，我们无法明确推荐预防手术伤口感染的首选给药方案。尽管需要未来的研究以确保我们的预防决策继续基于证据且具有成本效益，但单个临床试验不太可能提供答案。使用其他定量方法，如成本效益分析，可能有助于构建最佳预防策略模型。
