Table 1.
Characteristics of eligible studies.
| First Author, Year of Publication | Study Design | Evidence Level * | Number of Patients (Fractures) | GA Type | Antibiotic Type and Duration | Study Outcome | Follow-Up Period |
|---|---|---|---|---|---|---|---|
| Dellinger, 1988 [17] | RCT | Some concerns | 248 (264) | I, II, III | Group 1: 1 day of cefonicid sodium Group 2: 5 days of cefonicid sodium Group 3: 5 days of cefamandole nafate |
No significant difference in infection rates between group 1 (13%), group 2 (12%) and group 3 (13%) (p > 0.50) No significant difference in infection rates between group 1 (24%), group 2 (22%) and group 3 (21%) after isolating GA type III fractures (p > 0.90) |
2 months 1 |
| Dellinger, 1988 [18] | Retrospective case-control + | Moderate | 240 (263) | I, II, III | Cefonicid sodium, cefamandole nafate, cefazolin sodium 8 h vs. 1 day vs. 3 days vs. 4–5 days |
No significant difference in infection rates when comparing PAP duration of 8 h (15%) vs. 4–5 days (19%) by independent analysis of all patients (p > 0.50) No significant difference in infection rates when comparing PAP duration of 8 h vs. 4–5 days after multivariate correction for center, fracture grade, fixation method and fracture location (p = 0.90) |
3 months 2 |
| Carsenti-Etesse, 1999 [19] | RCT | Some concerns | 616 (616) | I, II | Group 1: Single dose of pefloxacin Group 2: 2 days of cefazolin, followed by 3 days of oxacillin |
No significant difference in infection rates between group 1 (6.6%) and group 2 (8.0%) (p = 0.51) | 3 months |
| Dunkel, 2013 [20] | Retrospective case-control | Moderate | 1290 (1492) | I, II, III | Multiple antibiotic types 1 day vs. 2–3 days vs. 4–5 days vs. more than 5 days |
No significant difference in infection rates when comparing 1 day of PAP vs. 2–3 days (OR 0.6, p = 0.65), 4–5 days (OR 1.2, p = 0.21) or more than 5 days (OR 1.4, p = 0.26) No significant difference in infection rates when comparing 1 day of PAP vs. 2–3 days (OR 0.3, p = 0.95), 4–5 days (OR 0.6, p = 0.24) or more than 5 days (OR 1.7, p = 0.43) after isolating GA type III fractures |
2 months 3 |
| Declercq, 2020 [21] | Retrospective case-control | Moderate | 502 (559) | I, II, III | Multiple antibiotic types Cut-off at 72 h |
No significant difference in infection rates when comparing PAP duration of up to 72 h vs. more than 72 h in all injuries (OR 3.61, p = 0.06) or after omitting GA type IIIB and IIIC fractures (OR 4.26, p = 0.07) Adjusted for LASSO selected predictors, PAP duration was independently associated with infection (OR 1.11 for every one day increase in PAP duration, p = 0.003) |
24 months |
| Stennett, 2020 [22] | Retrospective cohort |
Moderate | 2400 (2400) | I, II, III | Cephalosporin for all injuries. In type III injuries an aminoglycoside was added and in grossly contaminated injuries a penicillin was added Cut-off at 72 h |
No significant difference in infection rates when comparing PAP duration of up to 72 h vs. more than 72 h (OR 0.96, p = 0.81) In open fractures with mild contamination, extending PAP duration past 72 h was associated with increased odds of infection (OR 1.39, p = 0.12) In open fractures with severe contamination, extending PAP duration past 72 h was associated with decreased odds of infection (OR 0.20, p = 0.003) |
12 months |
GA: Gustilo-Anderson; LASSO: Least Absolute Shrinkage and Selection Operator; OR: Odds Ratio; PAP: Perioperative Antibiotic Prophylaxis; RCT: Randomized Controlled Trial; * As evaluated by the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) or the Risk Of Bias In Non-randomized Studies assessment tool (ROBINS-I); + Retrospective analysis of data collected in two prospective studies; 1 Overall, 78% of the included patients had a follow-up period of more than 2 months; 2 Overall, 93% of the included patients had a follow-up period of more than 3 months; 3 Follow-up ranged from 2 to 120 months, but infections occurring after two months were excluded, considering them hospital-acquired and not related to the initial open fracture management.