Meta-Analysis of Acute Systemic Antimicrobial Prophylaxis (ASAP) for Open Extremity Fracture Management: Subgroup Analysis and Methodological Guidelines

Acute Systemic Antimicrobial Prophylaxis (ASAP) is the standard of care for managing open fractures. There is concern that protocols do not address the modern open fracture bioburden. Online databases were searched to estimate the effect size in reducing the risk of postoperative infections in open fracture management stratified by regimen and fracture classification. 2,031 patients from 17 studies were analyzed. Meta-analysis of Type III open fractures suggested that Flucloxacillin + Benzylpenicillin had a lower infection rate than Cefazolin + Gentamicin; furthermore, the duration of hospitalization was extended by four days with Cefazolin + Gentamicin in Type II/III open fractures. No one antibiotic prophylactic regimen can be recommended over another in the management of open fractures with the current available data. We offer methodological guidelines for future trials that will allow robust evidence for future studies.