Effectiveness of antibiotic prophylaxis in polytrauma patients: a systematic review and meta-analysis.

IF 1.9 3区 医学 Q2 EMERGENCY MEDICINE
Karolina Dahms, Kelly Ansems, Julia Dormann, Eva Steinfeld, Heidrun Janka, Maria-Inti Metzendorf, Thomas Breuer, Carina Benstoem
{"title":"Effectiveness of antibiotic prophylaxis in polytrauma patients: a systematic review and meta-analysis.","authors":"Karolina Dahms, Kelly Ansems, Julia Dormann, Eva Steinfeld, Heidrun Janka, Maria-Inti Metzendorf, Thomas Breuer, Carina Benstoem","doi":"10.1007/s00068-025-02789-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients.</p><p><strong>Methods: </strong>We searched PubMed and the Cochrane Central Register of Controlled Trials to identify completed and ongoing studies from database inception to April 20, 2023. Eligible studies included systematic reviews and randomized controlled trials (RCTs) comparing antibiotic prophylaxis to placebo or standard care in adult polytrauma patients admitted to the intensive care unit (ICU).</p><p><strong>Results: </strong>Of 1237 identified records, three RCTs involving 256 patients (n<sub>antibiotics</sub> = 176, n<sub>control</sub> = 165, mean age 37.4 years, 81.6% male) were included. Antibiotic prophylaxis showed little or no effect on all-cause mortality compared to placebo or standard care (RR 1.01, 95% CI 0.55-1.85; RD 2 more per 1000, 95% CI -79 to 150; 2 studies, 209 participants; I<sup>2</sup> = 0%; very low certainty of evidence).</p><p><strong>Conclusion: </strong>The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.</p>","PeriodicalId":12064,"journal":{"name":"European Journal of Trauma and Emergency Surgery","volume":"51 1","pages":"105"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825575/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Trauma and Emergency Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00068-025-02789-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Purpose: The use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients.

Methods: We searched PubMed and the Cochrane Central Register of Controlled Trials to identify completed and ongoing studies from database inception to April 20, 2023. Eligible studies included systematic reviews and randomized controlled trials (RCTs) comparing antibiotic prophylaxis to placebo or standard care in adult polytrauma patients admitted to the intensive care unit (ICU).

Results: Of 1237 identified records, three RCTs involving 256 patients (nantibiotics = 176, ncontrol = 165, mean age 37.4 years, 81.6% male) were included. Antibiotic prophylaxis showed little or no effect on all-cause mortality compared to placebo or standard care (RR 1.01, 95% CI 0.55-1.85; RD 2 more per 1000, 95% CI -79 to 150; 2 studies, 209 participants; I2 = 0%; very low certainty of evidence).

Conclusion: The results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.

多重创伤患者抗生素预防的有效性:系统回顾和荟萃分析。
目的:由于抗生素耐药性的上升,在创伤患者中使用抗生素预防,特别是预防呼吸机相关性肺炎(VAP),一直存在争议。因此,本系统综述评估了抗生素预防与安慰剂或标准治疗对成人多发创伤患者临床结果的安全性和有效性。方法:我们检索PubMed和Cochrane中央对照试验注册库,以确定从数据库建立到2023年4月20日完成和正在进行的研究。符合条件的研究包括系统评价和随机对照试验(rct),比较重症监护病房(ICU)成人多发创伤患者的抗生素预防与安慰剂或标准治疗。结果:在1237份确定的记录中,纳入3项rct,共256例患者(未使用抗生素者176例,对照组165例,平均年龄37.4岁,男性81.6%)。与安慰剂或标准治疗相比,抗生素预防对全因死亡率的影响很小或没有影响(RR 1.01, 95% CI 0.55-1.85;每1000人中RD 2增加,95% CI -79 ~ 150;2项研究,209名受试者;i2 = 0%;证据的确定性非常低)。结论:与安慰剂或标准治疗相比,抗生素预防对成人多发外伤患者的死亡率和临床状况无显著影响,但可能降低VAP的发生风险。然而,证据已经过时,确定性很低,没有足够的数据来得出关于疗效的明确结论。因此,迫切需要高质量的最新研究来支持临床决策,目前的解释应谨慎对待。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信