Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery

Abstract

There is no consensus with regard to optimum prophylactic antibiotic regimen in orthopaedic fracture surgery. A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infection in patients undergoing operative treatment of low-energy closed fractures. Medline, Medline in Process and other non-indexed citations, Embase, Cochrane database of systematic reviews and conference proceedings were searched. Studies were included if they were randomized or quasi-randomized trials comparing the results of a single antibiotic prophylaxis versus multiple doses of the same antibiotic in patients undergoing surgical fixation of closed fractures. Four studies were found to meet the searching criteria. The mean score for quality assessment of these studies was 16 (8-24 points). Only two out of four studies had detailed analysable data and therefore were included in the final analysis. 921 patients were pooled using a random-effects model. Compared to multiple-dose prophylaxis, administration of a single preoperative dose demonstrated no significant difference regarding the overall surgical site infection rate (risk ratio (RR) = 0.3, 95% confidence interval (CI): 0.07-1.25). Multiple-dose antibiotic prophylaxis is marginally more effective than single dose in reducing the incidence of deep surgical wound infection (risk ratio: 0.13, 95% CI: 0.02 to 0.99). There is lack of definite evidence that multiple-dose antibiotic prophylaxis is superior to single preoperative dose in low-energy closed fracture surgery.