Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence

Abstract

Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.

Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

“…Subsequent meta-analyses in 2013, 2017, 2020 and one of pediatric patients in 2019 failed to show a benefit to systemic prophylaxis for the prevention of mortality. 6 97–99 In each of these studies there was significant variation in the type of prophylaxis used as well as the overall severity of the burns. While there is some evidence for the reduction of mortality in severely burned patients requiring mechanical ventilation with prophylactic antibiotics, no difference was found in patients not mechanically ventilated, and the effects on antibiotic resistance remain unknown.…”

“…4 5 While there is increasing question in the literature about the benefit of treating bite injuries with empiric antibiotics, there seems to be general consensus that injuries in high-risk locations (specifically hands, and over cartilage) and in high-risk patients should be treated. [4][5][6] Rabies treatment should also be considered and addressed with any mammalian bite wounds (table 1).…”

Prophylactic antibiotic use for penetrating trauma in prolonged casualty care: A review of the literature and current guidelines

“…52 Other studies on combat-related extremity trauma have included cases of isolated soft tissue trauma but do not include subgroup analyses of these cases separately from cases of fractures and other extremity trauma. 5,31,53 Combat-related extremity trauma has unique risks not reflected in the broader civilian trauma literature. Overall, the risk of posttraumatic infections in these cases is higher in amputations than in open fractures or soft tissue injuries, especially when following injury due to an improvised explosive device.…”

“…No benefit has been demonstrated from prolonged courses of antibiotics, with most studies and the resulting guidelines concluding that AP can be limited to the perioperative period but noting poor quality of the evidence. 5,[32][33][34][35][36][37][38][39][40][41] Similar to other injury locations, cefazolin is the preferred AP in combatrelated trauma, to be administered for 1 day following surgery; clindamycin is an acceptable alternative. 2,41…”

A novel, integrated approach for understanding and investigating Healthcare Associated Infections: A risk factors constellation analysis

“…This can be explained by the greater number of elderly patients (>65 years) in medical wards than in surgical wards; however, the difference in HAI incidence was not confirmed only considering patients under 65 years. We can therefore assume that perioperative prophylaxis in surgical wards plays a role in reducing infections [25] even if, particular attention must be paid to compliance with the protocol and to its duration to avoid the promotion of AMR insurgence [16,26,27].…”