开放性骨折治疗中的抗生素预防：当前实践与建议的系统综述
Antibiotic Prophylaxis in the Management of Open Fractures: A Systematic Survey of Current Practice and Recommendations.
作者信息
Chang Yaping, Bhandari Mohit, Zhu Kan Lun, Mirza Reza Donald, Ren Melody, Kennedy Sean Alexander, Negm Ahmed, Bhatnagar Neera, Naji Faysal N, Milovanovic Lazar, Fei Yutong, Agarwal Arnav, Kamran Rakhshan, Cho Sung Min, Schandelmaier Stefan, Wang Li, Jin Lin, Hu Shiyun, Zhao Yanping, Lopes Luciane Cruz, Wang Mei, Petrisor Brad, Ristevski Bill, Siemieniuk Reed A C, Guyatt Gordon H
机构信息
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.
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.
出版信息
JBJS Rev. 2019 Feb;7(2):e1. doi: 10.2106/JBJS.RVW.17.00197.
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.
背景
关于四肢开放性骨折患者抗生素预防的证据有限。因此，我们进行了一项系统调查，以探讨当前的实践情况和建议。
方法
我们纳入了2007年1月至2017年6月期间的出版物。我们检索了Embase、MEDLINE、CINAHL、Cochrane对照试验中央注册库（CENTRAL）以及Cochrane系统评价数据库，以查找临床研究和外科医生的调查；检索WorldCat以查找教科书；并检索网站以查找指南和机构方案。
结果
我们确定了223篇符合条件的出版物，这些出版物报告了100种关于全身抗生素给药的临床实践模式和276条建议，以及3条仅关于局部抗生素给药的建议。大多数临床实践模式的出版物使用了覆盖革兰氏阳性菌和革兰氏阴性菌的方案，并持续给药2至3天。大多数出版物推荐预防性全身使用抗生素。大多数建议表明，对于较轻的损伤采用革兰氏阳性菌覆盖，给药持续时间为3天或更短。对于更严重的损伤，大多数建议表明采用广泛的抗菌覆盖并持续2至3天。大多数出版物报告立即静脉注射抗生素。
结论
当前的实践和建议强烈支持对四肢开放性骨折患者尽早进行全身抗生素预防。在实践和建议中，抗生素方案、剂量和给药持续时间仍存在差异。关于最佳实践的共识可能需要精心设计的随机对照试验。
临床意义
当前的文献调查系统地提供了外科医生在2007年至2017年期间关于在四肢开放性骨折管理中使用预防性抗生素的实践情况和可用的专家建议。
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