TIME UNTIL THE START OF ANTIBIOTIC PROPHYLAXIS AND THE RISK OF OPEN FRACTURE INFECTION: A SYSTEMATIC REVIEW.

IF 0.5 4区 医学 Q4 ORTHOPEDICS Acta Ortopedica Brasileira Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI:10.1590/1413-785220243202e263176
João Guilherme Tavares Marchiori, Ana Paula Ferreira Nunes
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Abstract

Open fractures are highly incident injuries closely related to the modern life, in which accidents caused by motor vehicles or other machines impart high energy to bone tissue. Individual morbidity is represented by the functional impairment resultant of infection, nonunion, or vicious healing. In terms of public health, there are huge costs involved with the treatment of these fractures, particularly with their complications. One of the critical issues in managing open fractures is the use of antibiotics (ATB), including decisions about which specific agents to administer, duration of use, and ideal timing of the first prophylactic dose. Although recent guidelines have recommended starting antibiotic prophylaxis as soon as possible, such a recommendation appears to stem from insufficient evidence. In light of this, we conducted a systematic review, including studies that addressed the impact of the time to first antibiotic and the risk of infectious outcomes. Fourteen studies were selected, of which only four found that the early initiation of treatment with antibiotics is able to prevent infection. All studies had important risks of bias. The results indicate that this question remains open, and further prospective and methodologically sound studies are necessary in order to guide practices and health policies related to this matter. Level of Evidence II; Therapeutic Studies Investigating the Results Level of Treatment.

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抗生素预防措施开始前的时间与开放性骨折感染风险:系统综述。
开放性骨折是一种与现代生活密切相关的高发伤害,在现代生活中,机动车或其他机器造成的事故会对骨组织产生高能量。感染、不愈合或恶性愈合造成的功能障碍代表了个人发病率。就公共卫生而言,治疗这些骨折,尤其是治疗其并发症,需要花费巨额费用。处理开放性骨折的关键问题之一是抗生素(ATB)的使用,包括决定使用何种特定药物、使用时间以及首次预防性用药的理想时机。尽管最近的指南建议尽快开始抗生素预防治疗,但这种建议似乎缺乏足够的证据。有鉴于此,我们进行了一项系统性综述,其中包括有关首次使用抗生素的时间与感染性后果风险的影响的研究。我们选取了 14 项研究,其中只有 4 项研究发现尽早开始使用抗生素治疗能够预防感染。所有研究都存在严重的偏倚风险。研究结果表明,这一问题仍有待解决,有必要进一步开展前瞻性研究和方法学研究,以便为与此相关的实践和卫生政策提供指导。证据等级 II;调查治疗结果的治疗性研究。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
67
审稿时长
25 weeks
期刊介绍: A Revista Acta Ortopédica Brasileira, órgão oficial do Departamento de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo (DOT/FMUSP), é publicada bimestralmente em seis edições ao ano (jan/fev, mar/abr, maio/jun, jul/ago, set/out e nov/dez) com versão em inglês disponível nos principais indexadores nacionais e internacionais e instituições de ensino do Brasil. Sendo hoje reconhecidamente uma importante contribuição para os especialistas da área com sua seriedade e árduo trabalho para as indexações já conquistadas.
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