Dahms Karolina, Ansems Kelly, Dormann Julia, Steinfeld Eva, Janka Heidrun, Metzendorf Maria-Inti, Breuer Thomas, Benstoem Carina
Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Institute of General Practice, Medical Faculty of the Heinrich-Heine- University Dusseldorf, Dusseldorf, Germany.
Eur J Trauma Emerg Surg. 2025 Feb 13;51(1):105. doi: 10.1007/s00068-025-02789-8.
The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients.
We searched PubMed and the Cochrane Central Register of Controlled Trials to identify completed and ongoing studies from database inception to April 20, 2023. Eligible studies included systematic reviews and randomized controlled trials (RCTs) comparing antibiotic prophylaxis to placebo or standard care in adult polytrauma patients admitted to the intensive care unit (ICU).
Of 1237 identified records, three RCTs involving 256 patients (n = 176, n = 165, mean age 37.4 years, 81.6% male) were included. Antibiotic prophylaxis showed little or no effect on all-cause mortality compared to placebo or standard care (RR 1.01, 95% CI 0.55-1.85; RD 2 more per 1000, 95% CI -79 to 150; 2 studies, 209 participants; I = 0%; very low certainty of evidence).
The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.
由于抗生素耐药性不断上升，创伤患者使用抗生素预防，尤其是预防呼吸机相关性肺炎（VAP），存在争议。因此，本系统评价评估了与安慰剂或标准治疗相比，抗生素预防对成年多发伤患者临床结局的安全性和有效性。
我们检索了PubMed和Cochrane对照试验中央注册库，以识别从数据库建立至2023年4月20日完成和正在进行的研究。符合条件的研究包括系统评价和随机对照试验（RCT），比较抗生素预防与安慰剂或标准治疗在入住重症监护病房（ICU）的成年多发伤患者中的效果。
在1237条识别记录中，纳入了3项RCT，涉及256例患者（n = 176，n = 165，平均年龄37.4岁，81.6%为男性）。与安慰剂或标准治疗相比，抗生素预防对全因死亡率几乎没有影响（RR 1.01，95%CI 0.55 - 1.85；RD每1000人多2例，95%CI -79至150；2项研究，209名参与者；I² = 0%；证据确定性极低）。
结果表明，与安慰剂或标准治疗相比，抗生素预防对成年多发伤患者的死亡率和临床状况无显著影响，但可能降低VAP风险。然而，证据已过时且确定性极低，数据不足以就疗效得出明确结论。因此，迫切需要高质量、最新的研究来支持临床决策，当前的解释应谨慎对待。
