Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2021-10-14 eCollection Date: 2021-01-01 DOI:10.1155/2021/1949877

Eric K Kim, Claire A Donnelley, Madeline Tiee, Heather J Roberts, Ericka Von Kaeppler, David Shearer, Saam Morshed

{"title":"Prophylactic Topical Antibiotics in Fracture Repair and Spinal Fusion.","authors":"Eric K Kim, Claire A Donnelley, Madeline Tiee, Heather J Roberts, Ericka Von Kaeppler, David Shearer, Saam Morshed","doi":"10.1155/2021/1949877","DOIUrl":null,"url":null,"abstract":"Introduction: The objective of this systematic review with meta-analysis is to determine whether prophylactic local antibiotics prevent surgical site infections (SSIs) in instrumented spinal fusions and traumatic fracture repair. A secondary objective is to investigate the effect of vancomycin, a common local antibiotic of choice, on the microbiology of SSIs.Methods: An electronic search of PubMed, EMBASE, and Web of Science databases and major orthopedic surgery conferences was conducted to identify studies that (1) were instrumented spinal fusions or fracture repair and (2) had a treatment group that received prophylactic local antibiotics. Both randomized controlled trials (RCTs) and comparative observational studies were included. Meta-analysis was performed separately for randomized and nonrandomized studies with subgroup analysis by study design and antibiotic.Results: Our review includes 44 articles (30 instrumented spinal fusions and 14 fracture repairs). Intrawound antibiotics significantly decreased the risk of developing SSIs in RCTs of fracture repair (RR 0.61, 95% CI: 0.40-0.93, I 2 = 32.5%) but not RCTs of instrumented spinal fusion. Among observational studies, topical antibiotics significantly reduced the risk of SSIs in instrumented spinal fusions (OR 0.34, 95% CI: 0.27-0.43, I 2 = 52.4%) and in fracture repair (OR 0.49, 95% CI: 0.37-0.65, I 2 = 43.8%). Vancomycin powder decreased the risk of Gram-positive SSIs (OR 0.37, 95% CI: 0.27-0.51, I 2 = 0.0%) and had no effect on Gram-negative SSIs (OR 0.95, 95% CI: 0.62-1.44, I 2 = 0.0%).Conclusions: Prophylactic intrawound antibiotic administration decreases the risk of SSIs in fracture surgical fixation in randomized studies. Therapeutic efficacy in instrumented spinal fusion was seen in only nonrandomized studies. Vancomycin appears to be an effective agent against Gram-positive pathogens. There is no evidence that local vancomycin powder is associated with an increased risk for Gram-negative infection.","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2021-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531801/pdf/","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2021/1949877","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 5

Abstract

Introduction: The objective of this systematic review with meta-analysis is to determine whether prophylactic local antibiotics prevent surgical site infections (SSIs) in instrumented spinal fusions and traumatic fracture repair. A secondary objective is to investigate the effect of vancomycin, a common local antibiotic of choice, on the microbiology of SSIs.

Methods: An electronic search of PubMed, EMBASE, and Web of Science databases and major orthopedic surgery conferences was conducted to identify studies that (1) were instrumented spinal fusions or fracture repair and (2) had a treatment group that received prophylactic local antibiotics. Both randomized controlled trials (RCTs) and comparative observational studies were included. Meta-analysis was performed separately for randomized and nonrandomized studies with subgroup analysis by study design and antibiotic.

Results: Our review includes 44 articles (30 instrumented spinal fusions and 14 fracture repairs). Intrawound antibiotics significantly decreased the risk of developing SSIs in RCTs of fracture repair (RR 0.61, 95% CI: 0.40-0.93, I ² = 32.5%) but not RCTs of instrumented spinal fusion. Among observational studies, topical antibiotics significantly reduced the risk of SSIs in instrumented spinal fusions (OR 0.34, 95% CI: 0.27-0.43, I ² = 52.4%) and in fracture repair (OR 0.49, 95% CI: 0.37-0.65, I ² = 43.8%). Vancomycin powder decreased the risk of Gram-positive SSIs (OR 0.37, 95% CI: 0.27-0.51, I ² = 0.0%) and had no effect on Gram-negative SSIs (OR 0.95, 95% CI: 0.62-1.44, I ² = 0.0%).

Conclusions: Prophylactic intrawound antibiotic administration decreases the risk of SSIs in fracture surgical fixation in randomized studies. Therapeutic efficacy in instrumented spinal fusion was seen in only nonrandomized studies. Vancomycin appears to be an effective agent against Gram-positive pathogens. There is no evidence that local vancomycin powder is associated with an increased risk for Gram-negative infection.

Abstract Image

查看原文本刊更多论文

预防性局部抗生素在骨折修复和脊柱融合术中的应用。

引言：这项荟萃分析系统综述的目的是确定预防性局部抗生素是否能预防器械脊柱融合和创伤性骨折修复中的手术部位感染。第二个目的是研究万古霉素（一种常见的局部抗生素）对SSIs微生物学的影响。方法：电子检索PubMed、EMBASE、，进行了Web of Science数据库和主要骨科手术会议，以确定（1）器械脊柱融合或骨折修复的研究和（2）接受预防性局部抗生素的治疗组的研究。包括随机对照试验（RCT）和比较观察性研究。对随机和非随机研究分别进行荟萃分析，并根据研究设计和抗生素进行亚组分析。结果：我们的综述包括44篇文章（30例器械脊柱融合术和14例骨折修复）。在骨折修复的随机对照试验中，伤口内抗生素显著降低了发生SSIs的风险（RR 0.61，95%CI:0.40-0.93，I 2 = 32.5%），而不是器械脊柱融合的随机对照试验。在观察性研究中，外用抗生素显著降低了器械脊柱融合术中SSIs的风险（OR 0.34，95%CI:0.27-0.43，I 2 = 52.4%）和骨折修复（OR 0.49，95%CI:0.37-0.65，I2 = 43.8%）。万古霉素粉末可降低革兰氏阳性SSIs的风险（OR 0.37，95%CI:0.27-0.51，I2 = 0.0%），对革兰氏阴性SSIs无影响（OR 0.95，95%CI:0.62-1.44，I2 = 0.0%）。结论：在随机研究中，预防性伤口内抗生素给药可降低骨折手术固定中SSIs的风险。只有在非随机研究中观察到器械脊柱融合术的疗效。万古霉素似乎是对抗革兰氏阳性病原体的有效药物。没有证据表明局部万古霉素粉末与革兰氏阴性感染风险增加有关。

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

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.