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

Surgical site infections (SSI) complicate at least 5% of hand trauma operations; however, the efficacy of prophylactic antibiotics remains unclear. Unlike previous meta-analyses, this network meta-analysis (NMA) provides a definitive summary of all currently available data across multiple antibiotic classes, allowing indirect comparisons to provide a robust understanding of relative antibiotic effectiveness.

A systematic literature search was performed across EMBASE, MEDLINE, CINAHL, and CENTRAL, supplemented by Google Scholar and clinical trial registries. Prospective comparative studies comparing antibiotics versus placebo/no antibiotics in patients undergoing surgery for hand and wrist trauma were included. Data on SSI rates were extracted and analysed using network meta-analysis with frequentist random-effects models.

Some 4499 articles were screened, with 13 randomized controlled trials (RCT) and 2 non-randomized studies involving 3898 participants included in the analysis. The pooled SSI prevalence was 3.6%. Our NMA indicated that prophylactic antibiotics did not significantly reduce SSI risk compared to placebo: the highest-ranking treatment (mixed antibiotic regimen) demonstrating a relative risk of 0.29 (95% c.i. 0.04, 2.13). Subgroup analyses revealed no significant differences based on injury type or location of surgery.

There was insufficient evidence to support routine prophylactic antibiotic use in hand trauma surgery. Low event rates, wide confidence intervals, and moderate-to-high risk of bias in most included studies limit the certainty of this conclusion: the evidence remains inconclusive. Future high-quality RCTs are warranted to evaluate the benefit of antibiotic prophylaxis in hand trauma surgery.