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Prophylactic Antibiotic Use in Hand Surgery: A Systematic Review
James Lee, MD, Gaurav B. Jain, MD, Salah Aldekhayel, MD, Mario Luc, MD
McGill University, Montreal, QC, Canada

Introduction: Hand injuries are one of the most common types of trauma, and while there is clear evidence supporting antibiotic use in infected wounds, bites, or open fractures, there is great uncertainty with simpler hand lacerations or crush injuries. Currently, physician personal preference, experience, or patient expectation drives the use of prophylactic antibiotics in hand trauma. Prophylactic antibiotic use, if not needed, represents a major resource strain on health care systems. The emergence of super bugs, and the administration of unnecessary medication to patients are both concerning factors when considering prophylactic antibiotic use in patients.
Methods: We searched the Cochrane Library, OVID Embase, OVID Medline, PubMed, Scopus, and Google Scholar databases (all articles from 1990-2013) for Prospective Studies and Randomized Control Trials of prophylactic antibiotic usage in hand surgery. Studies of adults and children who required hand surgery for either traumatic hand lacerations (including skin, nerve, tendon, vessel damage), crush injuries, injuries with soft tissue loss (defect, abrasion, degloving) were included. Studies dealing with bites or open fractures were excluded. The references of these articles were reviewed by hand, and grey literature sources including currently ongoing clinical trials were investigated.
Results: A total of 11 studies were included in the review. Across all studies, 3980 patients received prophylactic antibiotics with an infection rate of 1.35%, while 7468 patients did not receive prophylactic antibiotics with an infection rate of 0.75%. This difference is not statistically significant.
Conclusion: This review shows that there is no clinical benefit to prophylactic antibiotic use in simple hand lacerations or injuries extending deeper and affecting tendons. Surgical irrigation and debridement are mainstays of treatment for hand injuries requiring surgery, and a reduction in the use of antibiotics will help curb the development of antibiotic-resistant organisms and reduce resource requirements.


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