Prophylactic Intrawound Antibiotics Significantly Reduce the Risk of Deep Infections in Fracture Fixation: Subgroup Metanalyses of the Type of Fracture, Antibiotics, and Organism.

Abstract

To analyze the efficacy of subgroups of various intrawound local antibiotics in reducing the rate of fracture-related infections (FRI). and study selection: PubMed, MEDLINE via Ovid, Web of Science, Cochrane database, and Science Direct were searched for articles in English on July 5, 2022 and December 15, 2022. All clinical studies comparing the incidence of FRI between administration of prophylactic systemic and topical antibiotics in fracture repair were analyzed. Cochrane collaboration's assessment tool and the methodological bias and the methodological index for nonrandomized studies were used to detect bias and evaluate the quality of included studies, respectively. Data synthesis: RevMan 5.3 software. (Nordic Cochrane Centre, Denmark) was used to conduct the meta-analyses and generate forest plots. From 1990 to 2021, 13 Studies included 5,309 patients. Non-stratified meta-analysis showed that intrawound administration of antibiotics significantly decreased the overall incidence of infection in both open and closed fractures, regardless of the severity of open fracture and antibiotics class [OR= 0.58, P= 0.007)] [OR= 0.33, P<0.00001)], respectively. The stratified analysis revealed that prophylactic intrawound antibiotics significantly lowered infection rate in open fracture patients with Gustilo-Anderson Type I (OR=0.13, p=0.004), Type II (OR=0.29, p=0.0002), Type III (OR=0.21, p<0.00001), when either Tobramycin PMMA beads (OR=0.29, p<0.00001), or vancomycin powder (OR=0.51, p=0.03) was applied. This study demonstrates prophylactic administration of intrawound antibiotics significantly decreases the overall incidence of infection in all subgroups of surgically fixated fractures but does not affect. Level II. See Instructions for Authors for a complete description of levels of evidence.