Prophylactic antibiotics in hand trauma surgery: a network meta-analysis.

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Evidence-Based Medicine

Background:

• Surgical site infections (SSI) affect over 5% of hand trauma operations.
• The effectiveness of prophylactic antibiotics for preventing SSIs in this population is uncertain.
• This network meta-analysis (NMA) synthesizes current data to compare multiple antibiotic classes.

Purpose of the Study:

• To definitively summarize available data on prophylactic antibiotic efficacy in hand trauma surgery.
• To conduct indirect comparisons of various antibiotic classes using NMA.
• To provide a robust understanding of relative antibiotic effectiveness for SSI prevention.

Main Methods:

• Systematic literature search across major databases (EMBASE, MEDLINE, CINAHL, CENTRAL) and trial registries.
• Inclusion of prospective comparative studies of antibiotics versus placebo/no antibiotics for hand/wrist trauma surgery.
• Network meta-analysis using frequentist random-effects models to analyze SSI rates.

Main Results:

• Analysis included 13 RCTs and 2 non-randomized studies (3898 participants).
• Pooled SSI prevalence was 3.6%.
• Prophylactic antibiotics did not significantly reduce SSI risk compared to placebo (RR 0.29; 95% CI 0.04, 2.13 for mixed regimens). Subgroup analyses showed no significant differences.

Conclusions:

• Insufficient evidence supports routine prophylactic antibiotic use in hand trauma surgery.
• Low event rates, wide confidence intervals, and risk of bias limit conclusion certainty.
• High-quality randomized controlled trials are warranted to definitively evaluate antibiotic prophylaxis benefits.