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Intervention Review

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Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures

  1. William J Gillespie1,*,
  2. Geert Walenkamp2

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 25 NOV 2000

DOI: 10.1002/14651858.CD000244


How to Cite

Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000244. DOI: 10.1002/14651858.CD000244.

Author Information

  1. 1

    University of Hull, Hull York Medical School, Hull, UK

  2. 2

    Academisch Ziekenhuis Maastricht, Orthopaedics, Maastricht , Maastricht, Netherlands

*William J Gillespie, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK. bill.gillespie@hyms.ac.uk. bill.gillespie@yahoo.co.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

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This is not the most recent version of the article. View current version (17 MAR 2010)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Wound infection and other hospital-acquired infections cause significant morbidity after internal fixation of fractures (osteosynthesis). The administration of antimicrobial agents (antibiotics) may reduce the frequency of infections.

Objectives

To determine whether the prophylactic administration of antibiotics in patients undergoing surgical management of hip or other long bone fractures reduces the incidence of wound and other hospital acquired infections.

Search strategy

We searched the The Cochrane Library, Issue 3 2000; MEDLINE, EMBASE, LILACS, Current Contents, Dissertation Abstracts, and Index to UK Theses to August 2000. Bibliographies of identified articles were screened for further relevant trials. No language restriction was applied.

Selection criteria

Randomised or quasi-randomised controlled trials involving -
Participants: Any patients with a hip or other closed long bone fracture undergoing surgery for internal fixation or replacement arthroplasty.
Interventions: Any regimen of systemic antibiotic prophylaxis administered at the time of surgery.
Outcome measures: Wound infection (deep and superficial), urinary tract infection, respiratory tract infection, adverse effects of prophylaxis, economic evaluations.

Data collection and analysis

Two reviewers independently screened papers for inclusion, assessed trial quality using an eight item scale, and extracted data. Additional information was sought from two trialists. Pooled data are presented graphically.

Main results

Data from 8307 participants in 22 studies were analysed. In patients undergoing surgery for closed fracture fixation, single dose antibiotic prophylaxis significantly reduced deep wound infection (risk ratio 0.40, 95% CI 0.24 to 0.67) superficial wound infections, urinary infections, and respiratory tract infections. Multiple dose prophylaxis had an effect of similar size on deep wound infection (risk ratio 0.40, 95% CI 0.24 to 0.67), but significant effects on urinary and respiratory infections were not confirmed. Economic modelling using data from one large trial indicates that single dose prophylaxis with ceftriaxone is a cost-effective intervention. There are limited data for the incidence of adverse effects, but as expected they appear to be more common in those receiving antibiotics, compared with placebo or no prophylaxis.

Authors' conclusions

Antibiotic prophylaxis should be offered to those undergoing surgery for closed fracture fixation.
On ethical grounds, further placebo controlled randomised trials of the effectiveness of antibiotic prophylaxis in closed fracture surgery are unlikely to be justified. Trials addressing the cost-effectiveness of different effective antibiotic regimens would need to be very large.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures

Wound infection and other hospital acquired infections can be life threatening in people following surgery for thigh and other long bone fractures. Antibiotics have been given routinely since the 1970s in an effort to reduce infections from bacteria such as staphylococcus. The review of trials found that antibiotics are effective in reducing the incidence of infection, both at the wound site and in the chest and urine. The effect of a single dose is similar to those from multi-doses if the antibiotic chosen is active through the period from the beginning to the end of surgery.