Systemic antibiotic prophylaxis for preventing infectious complications in maxillofacial trauma surgery: A Cochrane systematic review and metaanalyses
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Abstract
Background: Antibiotics are commonly administrated perioperatively to prevent
postoperative surgical site infection (SSI) of facial fractures treated with open reduction
and internal fixation (ORIF). However, there is no consensus on the optimal duration
and class of prophylactic antibiotics. We investigated the effect of different antibiotic
regimens and examined the efficacy and safety antibiotics for preventing complications
following the surgical reduction of facial fractures.
Methods: In October 2019, we searched the Cochrane Central Register of Controlled
Trials; Ovid MEDLINE; and Ovid EMBASE. We included randomized controlled trials
(RCTs) involving people undergoing ORIF for maxillofacial trauma surgery and
comparing one regimen of antibiotic prophylaxis with any other regimen, placebo or no
antibiotics. The primary outcomes were SSI and systemic infections. Secondary
outcomes were rate of retreatment surgery, adverse events, total treatment costs,
duration of stay in hospital and health-related quality of life. Two assessors examined
the title and abstracts of references identified in the literature search, extracted data
and assessed the risk of bias in included studies.
Main results: We included 14 RCTs in this review that reported the rate of SSI. We
pooled the studies into subgroups based on the prophylaxis regimen. Comparing
intraoperative prophylaxis and postoperative prophylaxis in terms of SSI showed no to
little difference between groups (RR 1.23, 95% CI 0.74 to 2.04; participants = 408;
studies = 5; I2 = 0%; moderate-quality evidence). Also, comparing short-term and longterm postoperative antibiotic prophylaxis showed no to little reduction in the risk of SSI
(RR 0.76, 95% CI 0.39 to 1.47; participants = 570; studies = 7; I2 = 0%; moderatequality evidence) and the risk of adverse events (RR 0.61, 95% CI 0.27 to 1.38;
participants = 295; studies = 4; I2 = 0%, high-quality evidence). There was no difference
in terms of retreatment surgery and systemic infections in both comparisons. Most
studies had an unclear risk of bias prompting us to downgrade the quality of evidence
for outcomes.
Conclusions: There is little or no difference between single-shot intraoperative
prophylaxis or short-term (<48 hours) or long-term (>48 hours) postoperative
prophylaxis in the rate of SSI and adverse events. The studies comparing antibiotic
prophylaxis for facial fractures other than mandibular fractures were scarce. Further
evidence for these fracture sites is needed