1. No Reduction in Surgical Site Infection Obtained with Post-Operative Antibiotics in Facial Fractures, Regardless of Duration or Anatomic Location: A Systematic Review and Meta-Analysis
- Author
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Patrick T. Delaplain, Jeffry Nahmias, Sebastian D. Schubl, Megan R. Lundeberg, Jacquelyn L Phillips, Linda S. Murphy, Viktor Gabriel, Areg Grigorian, Philip S. Barie, Catherine M. Kuza, Marija Pejcinovska, and Brian M. Sheehan
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Sciences ,antibiotics ,Time-to-Treatment ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Surgical Wound Infection ,Internal fixation ,030212 general & internal medicine ,Antibiotic prophylaxis ,Bone ,Orbital Fracture ,Facial Injuries ,Reduction (orthopedic surgery) ,0303 health sciences ,030306 microbiology ,Mandible Fracture ,business.industry ,facial fractures ,Incidence (epidemiology) ,Age Factors ,Evaluation of treatments and therapeutic interventions ,surgical site infections ,Injuries and accidents ,Odds ratio ,Antibiotic Prophylaxis ,Surgery ,Open Fracture Reduction ,Good Health and Well Being ,Infectious Diseases ,Meta-analysis ,business ,6.4 Surgery ,Fractures - Abstract
Background: We performed a systematic review of the literature on antibiotic prophylaxis practices in open reduction, and internal fixation of, facial fracture(s) (ORIFfx). We hypothesized that prolonged antibiotic prophylaxis (PAP) would not decrease the rate of surgical site infections (SSIs). Methods: We performed a systematic review of four databases: PubMed, CENTRAL, EMBase, and Web of Science, from inception through January 15, 2017. Three independent reviewers extracted fracture location (orbital, mid-face, mandible), antibiotic use, SSI incidence, and time from injury to surgery. Mantel-Haenszel and generalized estimating equations were carried out independently for each fracture zone. Results: Of the 587 articles identified, 54 underwent full-text review, yielding 27 studies that met our inclusion criteria. Of these, 16 studies (n = 2,316 patients) provided data for mandible fractures, four studies (n = 439) for mid-face fractures, and six studies (n = 377) for orbital fractures. Pooled analysis of each fracture type's SSI rate showed no statistically significant association with the odds ratio (OR) of developing an SSI. For mandible fractures treated with ORIFfx, the OR for an SSI after 24-72 hours of prophylaxis relative to 72 hours compared with 72 hours paradoxically may increase the SSI risk after mandible fracture repairs.
- Published
- 2020
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