The Role of Antibiotic Prophylaxis in Clean Incised Hand Injuries: A Prospective Randomized Placebo Controlled Double Blind Trial

Abstract

A prospective, randomized, double blind, placebo controlled trial was designed to investigate the effect of prophylactic flucloxacillin on the infection rate in clean incised hand injuries, which included trauma to skin, tendon and nerve in adults. Using strict exclusion criteria, a total of 170 patients were recruited into one of three trial groups; Group A - intravenous flucloxacillin on induction followed by an oral placebo; Group B - intravenous flucloxacillin on induction followed by an oral flucloxacillin course or Group C - oral placebo. Thirteen of the patients were subsequently withdrawn, leaving 92% available to complete the trial. Infection was diagnosed using clinical criteria. The infection rates in the three groups were Group A - 13%, Group B - 4% and Group C - 15%. Strictly, the results demonstrate no statistically significant difference in the infection rates between the groups.

Meta-analysis of antibiotics for simple hand injuries requiring surgery

“…Among the RCTs, the risk of bias was low in two relatively recent trials 17,25 , high in two trials 15,16 , and one older trial 26 did not describe its study design in sufficient detail to assess some forms of bias. All five prospective trials were at high risk of bias in at least one area, mostly owing to lack of blinding.…”

“…All 13 studies assessed the use of antibiotics following surgery for hand injuries, either as the whole study or as a separately tabulated subgroup. Five studies 17,19,22,25,26 had three arms, comparing different antibiotic regimens with a control group (Table S1, supporting information). Six Infected wound (class IV), typical of those excluded from this analysis.…”

“…Six Infected wound (class IV), typical of those excluded from this analysis. This appearance is suggestive of tenosynovitis, usually treated with urgent surgical washout, antibiotics and elevation studies 14,15,17,19,20,26 gave a cephalosporin, four 16,18,22,25 penicillin (flucloxacillin or co-amoxiclav) and three 21,23,24 included any antibiotic prescribed. The trials were statistically homogeneous (P = 0⋅77, χ 2 test, I 2 = 0 per cent), but a random-effects model was used owing to the heterogeneity of regimens.…”

“…Additional records identified through other sources n = 12 14 Aydın et al 15 Beesley et al 16 Berwald et al 17 Cassell and Ion 18 Grossman et al 19 Haughey et al 20 Platt and Page 21 Roberts and Teddy 22 Roodsari et al 23 Stone and Davidson 24 Whittaker et al 25 Worlock et al 26 Total Heterogeneity: τ 2 = 0·00; χ 2 = 8·16, 12 d.f., P = 0·77; I 2 = 0% Test for overall effect: Z = 0·69, P = 0·49 …”

Cephalosporins in Hand Surgery

“…[3][4][5][6][7] Prophylactic antibiotics reduce the rate of postoperative infection after clean orthopedic procedures lasting greater than 2 hours without prosthetic implantation. 8,9 In addition, complex reconstructive and microvascular procedures have a decreased incidence of infection with preoperative antibiotic use. 10 The absolute indications for the administration of prophylactic antibiotics in hand surgery include clean elective procedures greater than 2 hours duration, complex reconstructions, and treatment of dirty wounds such as animal and human bite injuries.…”