Comparing piperacillin/tazobactam to current guidelines for the treatment of open fractures: A systematic review

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2024-11-01 DOI:10.1016/j.jor.2024.10.059

Eric Kholodovsky , Dylan Luxenburg , William Marmor , Ashleigh Gibula , Giselle Hernandez

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引用次数: 0

Abstract

Background

Current guidelines call for the use of a first-generation cephalosporin with or without an aminoglycoside for the treatment of open fractures. Due to its superior safety profile and single-dose administration, Piperacillin/tazobactam (PT) may be an effective alternative. The present systematic literature review aimed to evaluate the hypothesis that PT antibiotic prophylaxis does not differ in clinical outcomes as compared to the current guidelines in the treatment of open fractures.

Methods

Five databases were queried for literature pertaining to PT administration for open fractures. A 2-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodologic index for non-randomized studies criteria was used to objectively assess the methodologic quality of the studies reviewed. Retrospective cohort studies that compared PT to current guidelines in open fractures were included.

Results

Four retrospective cohort studies consisting of 752 patients were included. The injury severity score (ISS) score was higher for the PT group, 18.1, versus the control group, 14.5 (p = .0008). Seventy-eight patients developed a surgical site infection (SSI) in the PT group versus 67 patients in the control group (p = .82). Twenty-one patients developed an acute kidney injury (AKI) in the PT group versus 19 in the control group (p = .51). There was no difference in the number of patients who developed resistant pathogens (6 (PT group) vs. 1 (control group); p = .99). Length of stay was greater in the PT group, 16.4 days, compared to the control group, 10.5 days (p=<0.00001).

Conclusion

The use of piperacillin/tazobactam for open fractures does not differ from first-generation cephalosporins with or without an aminoglycoside in regard to SSI, AKI, return to operating room, 1-year mortality, non-union, and development of resistant pathogens. LOS was significantly longer in the PT group but may be explained by a greater ISS. PT may be a non-inferior alternative to current guidelines due to its better safety profile and single-dose administration method, however, this review is limited by the lack of side effect reporting and underscores the need for larger prospective studies that compare side effect profiles between PT and control groups.

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将哌拉西林/他唑巴坦与治疗开放性骨折的现行指南进行比较：系统回顾

背景现行指南要求使用第一代头孢菌素联合或不联合氨基糖苷类药物治疗开放性骨折。哌拉西林/他唑巴坦（Piperacillin/tazobactam，PT）因其卓越的安全性和单剂量给药，可能是一种有效的替代方案。本系统性文献综述旨在评估一个假设，即在治疗开放性骨折时，哌拉西林/他唑巴坦抗生素预防性用药的临床效果与现行指南相比并无不同。根据《系统综述和荟萃分析首选报告项目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses），由两名作者进行筛选。非随机研究的方法学指数标准用于客观评估所审查研究的方法学质量。结果四项回顾性队列研究共纳入了 752 名患者。PT组的损伤严重程度评分（ISS）为18.1分，高于对照组的14.5分（P = 0.0008）。PT 组 78 名患者发生了手术部位感染 (SSI)，而对照组为 67 名（P = .82）。PT 组有 21 名患者出现急性肾损伤 (AKI)，对照组为 19 名（P = .51）。出现耐药病原体的患者人数没有差异（6 例（试验组）对 1 例（对照组）；P = .99）。结论在SSI、AKI、返回手术室、1年死亡率、不愈合和耐药病原体的产生方面，使用哌拉西林/他唑巴坦治疗开放性骨折与使用或不使用氨基糖苷类药物的第一代头孢菌素没有区别。PT组的LOS明显更长，但这可能是由于ISS更多所致。由于 PT 具有更好的安全性和单剂量给药方法，它可能是现行指南的一种非劣效替代方案，但由于缺乏副作用报告，本综述受到了限制，因此强调需要进行更大规模的前瞻性研究，比较 PT 组和对照组的副作用情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.