Protocol for a systematic review and network meta-analysis of the use of prophylactic antibiotics in hand trauma surgery.
Antibiotic
Hand
Network meta-analysis
Surgical site infection
Wrist
Journal
Systematic reviews
ISSN: 2046-4053
Titre abrégé: Syst Rev
Pays: England
ID NLM: 101580575
Informations de publication
Date de publication:
14 Jun 2024
14 Jun 2024
Historique:
received:
21
09
2023
accepted:
28
05
2024
medline:
15
6
2024
pubmed:
15
6
2024
entrez:
14
6
2024
Statut:
epublish
Résumé
The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery. The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta-Analysis (CINEMA). This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing. PROSPERO CRD42023429618.
Sections du résumé
BACKGROUND
BACKGROUND
The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.
METHODS AND ANALYSIS
METHODS
The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta-Analysis (CINEMA).
DISCUSSION
CONCLUSIONS
This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing.
SYSTEMATIC REVIEW REGISTRATION
BACKGROUND
PROSPERO CRD42023429618.
Identifiants
pubmed: 38877569
doi: 10.1186/s13643-024-02573-6
pii: 10.1186/s13643-024-02573-6
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
157Subventions
Organisme : National Institute for Health and Care Research
ID : CL-2021-02-002
Organisme : British Society for Surgery of the Hand
ID : 100006082
Informations de copyright
© 2024. The Author(s).
Références
Statistics » A&E attendances and emergency admissions. Available from: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/ . Cited 2023 Aug 16
Manley OWG, Wormald JCR, Furniss D. The changing shape of hand trauma: an analysis of Hospital Episode Statistics in England. J Hand Surg Eur. 2019;44(5):532–6.
doi: 10.1177/1753193419828986
O’Sullivan ME, Colville J. The economic impact of hand injuries. J Hand Surg Edinb Scotl. 1993;18(3):395–8.
doi: 10.1016/0266-7681(93)90072-N
Rosberg HE, Carlsson KS, Cederlund RI, Ramel E, Dahlin LB. Costs and outcome for serious hand and arm injuries during the first year after trauma – a prospective study. BMC Public Health. 2013;13(1):501.
doi: 10.1186/1471-2458-13-501
pubmed: 23706070
pmcid: 3681586
The economic impact of hand injuries. Available from: https://journals.sagepub.com/doi/epdf/10.1016/0266-7681%2893%2990072-N . Cited 2023 Aug 21
Baldwin AJ, Jackowski A, Jamal A, Vaz J, Rodrigues JN, Tyler M, et al. Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: a cohort study. J Plast Reconstr Aesthet Surg. 2021;74(11):3080–6.
doi: 10.1016/j.bjps.2021.06.016
pubmed: 34303636
pmcid: 8259108
Platt AJ, Page RE. Post-operative infection following hand surgery: guidelines for antibiotic use. J Hand Surg. 1995;20(5):685–90.
doi: 10.1016/S0266-7681(05)80137-8
Dunn JC, Means KR, Desale S, Giladi AM. Antibiotic use in hand surgery: surgeon decision making and adherence to available evidence. Hand N Y N. 2020;15(4):534–41.
doi: 10.1177/1558944718812161
Shapiro LM, Zhuang T, Li K, Kamal RN. The use of preoperative antibiotics in elective soft-tissue procedures in the hand: a critical analysis review. [Review]. JBJS Rev. 2019;7(8):e6.
doi: 10.2106/JBJS.RVW.18.00168
pubmed: 31436581
pmcid: 7199608
Kistler JM, Munn M, McEntee R, Ilyas AM. Antibiotic prophylaxis in clean hand surgery: a prospective cohort analysis of major and minor complications. J Hand Surg Glob Online. 2023;5(4):421–5.
doi: 10.1016/j.jhsg.2023.03.011
pubmed: 37521558
pmcid: 10382872
Bäcker HC, Freibott CE, Wilbur D, Tang P, Barth R, Strauch RJ, et al. Prospective analysis of hand infection rates in elective soft tissue procedures of the hand: the role of preoperative antibiotics. Hand N Y N. 2021;16(1):81–5.
doi: 10.1177/1558944719842238
Murphy GRF, Gardiner MD, Glass GE, Kreis IA, Jain A, Hettiaratchy S. Meta-analysis of antibiotics for simple hand injuries requiring surgery. Br J Surg. 2016;103(5):487–92.
doi: 10.1002/bjs.10111
pubmed: 26928808
Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods. 2012;3(2):80–97.
doi: 10.1002/jrsm.1037
pubmed: 26062083
Salanti G, Ades AE, Ioannidis JPA. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.
doi: 10.1016/j.jclinepi.2010.03.016
pubmed: 20688472
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–84.
doi: 10.7326/M14-2385
pubmed: 26030634
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283.
doi: 10.2146/ajhp120568
pubmed: 23327981
Borchardt RA, Tzizik D. Update on surgical site infections: the new CDC guidelines. JAAPA Off J Am Acad Phys Assist. 2018;31(4):52–4.
Haddaway NR, Grainger MJ, Gray CT. Citationchaser: a tool for transparent and efficient forward and backward citation chasing in systematic searching. Res Synth Methods. 2022;13(4):533–45.
doi: 10.1002/jrsm.1563
pubmed: 35472127
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;28(366): l4898.
doi: 10.1136/bmj.l4898
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Cited 2024 May 31.
Efthimiou O, Debray TPA, van Valkenhoef G, Trelle S, Panayidou K, Moons KGM, et al. GetReal in network meta-analysis: a review of the methodology. Res Synth Methods. 2016;7(3):236–63.
doi: 10.1002/jrsm.1195
pubmed: 26754852
Jagodzinski NA, Ibish S, Furniss D. Surgical site infection after hand surgery outside the operating theatre: a systematic review. J Hand Surg Eur. 2017;42(3):289–94.
doi: 10.1177/1753193416676408
Davies J, Roberts T, Limb R, Mather D, Thornton D, Wade RG. Time to surgery for open hand injuries and the risk of surgical site infection: a prospective multicentre cohort study. J Hand Surg Eur. 2020;45(6):622–8.
doi: 10.1177/1753193420905205
Cassell OCS, Ion L. Are antibiotics necessary in the surgical management of upper limb lacerations? Br J Plast Surg. 1997;50(7):523–9.
doi: 10.1016/S0007-1226(97)91301-1
pubmed: 9422950
Balduzzi S, Rücker G, Nikolakopoulou A, Papakonstantinou T, Salanti G, Efthimiou O, et al. netmeta: an R package for network meta-analysis using frequentist methods. J Stat Softw. 2023;23(106):1–40.
Efthimiou O, Mavridis D, Debray TPA, Samara M, Belger M, Siontis GCM, et al. Combining randomized and non-randomized evidence in network meta-analysis. Stat Med. 2017;36(8):1210–26.
doi: 10.1002/sim.7223
pubmed: 28083901
Rücker G, Schwarzer G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol. 2015;15(1):58.
doi: 10.1186/s12874-015-0060-8
pubmed: 26227148
pmcid: 4521472
Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods. 2012;3(2):98–110.
doi: 10.1002/jrsm.1044
pubmed: 26062084
pmcid: 4433772
König J, Krahn U, Binder H. Visualizing the flow of evidence in network meta-analysis and characterizing mixed treatment comparisons. Stat Med. 2013;32(30):5414–29.
doi: 10.1002/sim.6001
pubmed: 24123165
Krahn U, Binder H, König J. A graphical tool for locating inconsistency in network meta-analyses. BMC Med Res Methodol. 2013;13(1):35.
doi: 10.1186/1471-2288-13-35
pubmed: 23496991
pmcid: 3644268
Efthimiou O, Rücker G, Schwarzer G, Higgins JPT, Egger M, Salanti G. Network meta-analysis of rare events using the Mantel-Haenszel method. Stat Med. 2019;38(16):2992–3012.
doi: 10.1002/sim.8158
pubmed: 30997687
Nikolakopoulou A, Higgins JPT, Papakonstantinou T, Chaimani A, Giovane CD, Egger M, et al. CINeMA: an approach for assessing confidence in the results of a network meta-analysis. Plos Med. 2020;17(4): e1003082.
doi: 10.1371/journal.pmed.1003082
pubmed: 32243458
pmcid: 7122720
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1.
doi: 10.18637/jss.v036.i03
Quality statement 2: antibiotic prophylaxis | surgical site infection | quality standards | NICE. NICE; 2013. Available from: https://www.nice.org.uk/guidance/qs49/chapter/quality-statement-2-antibiotic-prophylaxis . Cited 2023 Sep 6
Ketonis C, Dwyer J, Ilyas AM. Timing of debridement and infection rates in open fractures of the hand. Hand N Y N. 2017;12(2):119–26.
doi: 10.1177/1558944716643294
Stevenson J, Mcnaughton G, Riley J. The use of prophylactic flucloxacillin in treatment of open fractures of the distal phalanx within an accident and emergency department: a double-blind randomized placebo-controlled trial. J Hand Surg. 2003;28(5):388–94.
doi: 10.1016/S0266-7681(03)00175-X
Aydin N, Uraloğlu M, Burhanoğlu ADY, Sensöz Ö. A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg. 2010;126(5):1617–23.
doi: 10.1097/PRS.0b013e3181ef90cb
pubmed: 20639802