Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts
Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for...
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| Veröffentlicht in: | PloS one 2014-11, Vol.9 (11), p.e113676-e113676 |
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| creator | Poole, Daniele Chieregato, Arturo Langer, Martin Viaggi, Bruno Cingolani, Emiliano Malacarne, Paolo Mengoli, Francesca Nardi, Giuseppe Nascimben, Ennio Riccioni, Luigi Turriziani, Ilaria Volpi, Annalisa Coniglio, Carlo Gordini, Giovanni |
| description | Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field.
The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more, outweighed potential benefits.
When accounting for antibiotic-resistant bacteria selection we found no evidence in favour of antibiotic prophylaxis lasting two or more days in the studied clinical conditions. |
| doi_str_mv | 10.1371/journal.pone.0113676 |
| format | Article |
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The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more, outweighed potential benefits.
When accounting for antibiotic-resistant bacteria selection we found no evidence in favour of antibiotic prophylaxis lasting two or more days in the studied clinical conditions.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0113676</identifier><identifier>PMID: 25412442</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abdomen ; Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis ; Antibiotic resistance ; Antibiotics ; Bacteria ; Bone (long) ; Brain ; Clinical trials ; Coma ; Coma - pathology ; Consensus ; Contamination ; Databases, Factual ; Drug resistance ; Drug Resistance, Bacterial - drug effects ; Escherichia coli ; Evaluation ; Evidence-Based Medicine ; Fractures ; Guidelines ; Head injuries ; Health aspects ; Humans ; Infections ; Italy ; Klebsiella aerogenes ; Literature reviews ; Long bone ; Medicine and Health Sciences ; Meningitis ; Mortality ; Observational studies ; Patients ; Pneumonia ; Pneumonia, Ventilator-Associated - complications ; Pneumonia, Ventilator-Associated - drug therapy ; Prevention ; Prophylaxis ; Quality ; Staphylococcus aureus ; Studies ; Surgery ; Surgical site infections ; Surgical Wound Infection - prevention & control ; Traumatic brain injury ; Wounds ; Wounds and Injuries - complications ; Wounds and Injuries - pathology</subject><ispartof>PloS one, 2014-11, Vol.9 (11), p.e113676-e113676</ispartof><rights>COPYRIGHT 2014 Public Library of Science</rights><rights>2014 Poole et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2014 Poole et al 2014 Poole et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b20d1e5373f30c73349ae27c4424cdf16ce278fe0f7647a87fca8f40ccc9531a3</citedby><cites>FETCH-LOGICAL-c692t-b20d1e5373f30c73349ae27c4424cdf16ce278fe0f7647a87fca8f40ccc9531a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239082/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239082/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25412442$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Zhou, Zhi</contributor><creatorcontrib>Poole, Daniele</creatorcontrib><creatorcontrib>Chieregato, Arturo</creatorcontrib><creatorcontrib>Langer, Martin</creatorcontrib><creatorcontrib>Viaggi, Bruno</creatorcontrib><creatorcontrib>Cingolani, Emiliano</creatorcontrib><creatorcontrib>Malacarne, Paolo</creatorcontrib><creatorcontrib>Mengoli, Francesca</creatorcontrib><creatorcontrib>Nardi, Giuseppe</creatorcontrib><creatorcontrib>Nascimben, Ennio</creatorcontrib><creatorcontrib>Riccioni, Luigi</creatorcontrib><creatorcontrib>Turriziani, Ilaria</creatorcontrib><creatorcontrib>Volpi, Annalisa</creatorcontrib><creatorcontrib>Coniglio, Carlo</creatorcontrib><creatorcontrib>Gordini, Giovanni</creatorcontrib><creatorcontrib>Trauma Update Working Group</creatorcontrib><creatorcontrib>on behalf of the Trauma Update Working Group</creatorcontrib><title>Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field.
The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more, outweighed potential benefits.
When accounting for antibiotic-resistant bacteria selection we found no evidence in favour of antibiotic prophylaxis lasting two or more days in the studied clinical conditions.</description><subject>Abdomen</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotic Prophylaxis</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Bacteria</subject><subject>Bone (long)</subject><subject>Brain</subject><subject>Clinical trials</subject><subject>Coma</subject><subject>Coma - pathology</subject><subject>Consensus</subject><subject>Contamination</subject><subject>Databases, Factual</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial - drug effects</subject><subject>Escherichia coli</subject><subject>Evaluation</subject><subject>Evidence-Based Medicine</subject><subject>Fractures</subject><subject>Guidelines</subject><subject>Head injuries</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infections</subject><subject>Italy</subject><subject>Klebsiella aerogenes</subject><subject>Literature reviews</subject><subject>Long bone</subject><subject>Medicine and Health Sciences</subject><subject>Meningitis</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>Pneumonia, Ventilator-Associated - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Poole, Daniele</au><au>Chieregato, Arturo</au><au>Langer, Martin</au><au>Viaggi, Bruno</au><au>Cingolani, Emiliano</au><au>Malacarne, Paolo</au><au>Mengoli, Francesca</au><au>Nardi, Giuseppe</au><au>Nascimben, Ennio</au><au>Riccioni, Luigi</au><au>Turriziani, Ilaria</au><au>Volpi, Annalisa</au><au>Coniglio, Carlo</au><au>Gordini, Giovanni</au><au>Zhou, Zhi</au><aucorp>Trauma Update Working Group</aucorp><aucorp>on behalf of the Trauma Update Working Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2014-11-20</date><risdate>2014</risdate><volume>9</volume><issue>11</issue><spage>e113676</spage><epage>e113676</epage><pages>e113676-e113676</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Antibiotic prophylaxis is frequently administered in severe trauma. However, the risk of selecting resistant bacteria, a major issue especially in critical care environments, has not been sufficiently investigated. The aim of the present study was to provide guidelines for antibiotic prophylaxis for four different trauma-related clinical conditions, taking into account the risks of antibiotic-resistant bacteria selection, thus innovating previous guidelines in the field.
The MEDLINE database was searched for studies comparing antibiotic prophylaxis to controls (placebo or no antibiotic administration) in four clinical traumatic conditions that were selected on the basis of the traumatic event frequency and/or infection severity. The selected studies focused on the prevention of early ventilator associated pneumonia (VAP) in comatose patients with traumatic brain injury, of meningitis in severe basilar skull fractures, of wound infections in long-bone open fractures. Since no placebo-controlled study was available for deep surgical site-infections prevention in abdominal trauma with enteric contamination, we compared 24-hour and 5-day antibiotic prophylaxis policies. A separate specific research focused on the question of antibiotic-resistant bacteria selection caused by antibiotic prophylaxis, an issue not adequately investigated by the selected studies. Randomised trials, reviews, meta-analyses, observational studies were included. Data extraction was carried out by one author according to a predefined protocol, using an electronic form. The strength of evidence was stratified and recommendations were given according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
Uncertain evidence deserving further studies was found for two-dose antibiotic prophylaxis for early VAP prevention in comatose patients. In the other cases the risk of resistant-bacteria selection caused by antibiotic administration for 48 hours or more, outweighed potential benefits.
When accounting for antibiotic-resistant bacteria selection we found no evidence in favour of antibiotic prophylaxis lasting two or more days in the studied clinical conditions.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25412442</pmid><doi>10.1371/journal.pone.0113676</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2014-11, Vol.9 (11), p.e113676-e113676 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1626535049 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abdomen Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibiotic Prophylaxis Antibiotic resistance Antibiotics Bacteria Bone (long) Brain Clinical trials Coma Coma - pathology Consensus Contamination Databases, Factual Drug resistance Drug Resistance, Bacterial - drug effects Escherichia coli Evaluation Evidence-Based Medicine Fractures Guidelines Head injuries Health aspects Humans Infections Italy Klebsiella aerogenes Literature reviews Long bone Medicine and Health Sciences Meningitis Mortality Observational studies Patients Pneumonia Pneumonia, Ventilator-Associated - complications Pneumonia, Ventilator-Associated - drug therapy Prevention Prophylaxis Quality Staphylococcus aureus Studies Surgery Surgical site infections Surgical Wound Infection - prevention & control Traumatic brain injury Wounds Wounds and Injuries - complications Wounds and Injuries - pathology |
| title | Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts |
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