Antibiotic prophylaxis and other factors influencing infection risk reduction in hand and forearm fracture surgery: A narrative review.

Andrzej Żyluk
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Abstract

Surgical site infection is a serious complication of fracture surgery that often requires antibiotic treatment, implant removal, and wound debridement. Antibiotic prophylaxis is one of the measures taken to reduce the risk of surgical site infection. Other factors influencing the risk of infection include leaving the ends of the K-wires protruding through the skin vs. buried under the skin, operating under full sterility vs. field sterility in the operating room, or the burden of comorbidities. The purpose of this study was to review the current literature on antibiotic prophylaxis and other factors that influence the risk of infection during surgery for hand and distal radial fractures. We also reviewed the literature on potential adverse effects and costs of antibiotic prophylaxis. Results. Three studies and one systematic review were identified for the operative treatment of closed hand and distal radius fractures, none of which supported the routine use of antibiotic prophylaxis. For leaving the ends of K-wires exposed versus burying them under the skin, two articles were found. One reported an increased risk of surgical site infection when K-wires are left exposed, and the other reported that it does not matter. Three studies reported harmful and adverse effects of unnecessary use of antibiotic prophylaxis. Two studies reported an increased risk of surgical site infection in patients with comorbidities, compromised immunity, smoking, and alcohol use. The routine use of antibiotic prophylaxis generates significant costs that can be avoided if it is used as recommended by evidence-based medicine. Conclusion. The authors believe that this review may have many beneficial effects for patients and the health care system, such as: preventing bacterial resistance, increasing the efficacy of antibiotics in true infections, reducing the risk of adverse reactions, and reducing health care costs.

抗生素预防和其他影响手部和前臂骨折手术感染风险降低的因素:叙述性回顾。
手术部位感染是骨折手术的严重并发症,通常需要抗生素治疗、移除植入物和伤口清创。抗生素预防是减少手术部位感染风险的措施之一。其他影响感染风险的因素包括将克氏针的末端从皮肤中伸出还是埋在皮肤下,在手术室中完全无菌还是野外无菌操作,或者合并症的负担。本研究的目的是回顾目前关于手部和桡骨远端骨折手术中抗生素预防和其他影响感染风险因素的文献。我们还回顾了有关抗生素预防的潜在不良反应和成本的文献。结果。3项研究和1项系统综述确定了闭合性手和桡骨远端骨折的手术治疗,没有一项研究支持常规使用抗生素预防。对于将k线的末端暴露在外与将其埋在皮肤下,发现了两种物品。一份报告称,当k线暴露在外时,手术部位感染的风险增加,而另一份报告称这无关紧要。三项研究报告了不必要使用抗生素预防的有害和不良影响。两项研究报告了合并症、免疫力低下、吸烟和饮酒患者手术部位感染的风险增加。常规使用抗生素预防会产生巨大的费用,如果按照循证医学的建议使用,则可以避免这种费用。结论。作者认为,这一综述可能对患者和卫生保健系统有许多有益的影响,如:预防细菌耐药性,提高抗生素在真感染中的疗效,降低不良反应的风险,降低卫生保健费用。
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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