Eficácia da antibioticoprofilaxia em fraturas fechadas: revisão sistemática e metanálise

Abstract

There is a concern among orthopedists to avoid an infection in the surgical treatment of closed fractures, which could cause various complications at the surgical site, such as osteomyelitis. Although the medical literature has some meta-analyzes that address the topic, we do not have a more current one that also compares the non-use of antibiotic prophylaxis. To update orthopedists and show if there is any change in the topic, this meta-analysis aims to assess the need for the use of antibiotic prophylaxis to prevent infections at the surgical site of closed orthopedic fractures, comparing which method would be better: single dose of antibiotic, several doses, or not performing antibiotic prophylaxis. A search for randomized clinical trials was carried out in the databases Pubmed, Medline, Scielo, Scopus, Cochrane Library and Google Scholar, obtaining a total of 26 articles for the meta-analysis. When analyzing the comparisons that assess or not use antibiotic prophylaxis, perform a dose shown a 24% reduction in the chance of infection, while performing multiple doses produce a 62% reduction in infection after surgical treatment of closed fractures. Between the two forms of antibiotic prophylaxis (single dose versus multiple doses), there is a reduction of only 7% in infection when using multiple doses, but without statistical significance. We conclude, therefore, that the use of antibiotic prophylaxis is effective in preventing infections in the treatment of closed orthopedic fractures, and that there is no difference between one dose or multiple doses, obtaining in both the same result: a decrease in the percentage of postoperative infection.