J Orthop Trauma. 2022 Sep 6. doi: 10.1097/BOT.0000000000002487. Online ahead of print.
ABSTRACT
OBJECTIVES: Despite the use of systemic antibiotic prophylaxis, postoperative infection following fracture surgery remains an issue. The purpose of this systematic review and meta-analysis was to evaluate the effect of locally applied antibiotics on deep infection in fracture surgery in both open and closed fractures.
DATA SOURCES: A comprehensive search of Medline, EMBASE, and PubMed was performed from date of inception to April 15th, 2021 and included studies in all languages.
STUDY SELECTION: Cohort studies were eligible if they investigated the effect on infection rate of local antibiotic prophylaxis on deep infection following fracture surgery.
DATA EXTRACTION: The study was conducted according to the Cochrane Handbook for Systematic Reviews and reported as per the PRISMA guidelines. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool for randomized trials and the MINORS tool where applicable.
DATA SYNTHESIS: An inverse-variance random-effects model was the primary analysis model because of the anticipated diversity in the evaluated populations. Univariate models were employed when a single outcome was of interest.
CONCLUSIONS: The risk of deep infection was significantly reduced when local antibiotics were applied compared with the control group receiving systemic prophylaxis only. This beneficial effect was observed in open fractures but failed to reach statistical significance in closed fractures. This meta-analysis suggests there may be a significant risk reduction in deep infection rate following fracture surgery when local antibiotics are added to standard systemic prophylaxis, particularly in open fractures. Further high-powered Level I studies are needed to support these findings.
LEVEL OF EVIDENCE: III See Instructions for Authors for a complete description of levels of evidence.
PMID:36084224 | DOI:10.1097/BOT.0000000000002487
