title: Meta-analysis of antibiotics for simple hand injuries requiring surgery.
abstract: BACKGROUND
  Simple hand trauma is very common, accounting for 1·8 million emergency department visits annually in the USA alone. Antibiotics are used widely as postinjury prophylaxis, but their efficacy is unclear. This meta-analysis assessed the effect of antibiotic prophylaxis versus placebo or no treatment on wound infection rates in hand injuries managed surgically.
  
  
  METHODS
  Embase, MEDLINE, PubMed, Cochrane Central, ClinicalTrials.gov and the World Health Organization International Clinical Trials Portal were searched for published and unpublished studies in any language from inception to September 2015. The primary outcome was the effect of antibiotic prophylaxis on wound infection rates. Open fractures, crush injuries and bite wounds were excluded. Study quality was assessed using the Cochrane risk-of-bias tool. Data were pooled using random-effects meta-analysis, and risk ratios (RRs) and 95 per cent c.i. obtained.
  
  
  RESULTS
  Thirteen studies (2578 patients) were included, comprising five double-blind randomized clinical trials, five prospective trials and three cohort studies. There was no significant difference in infection rate between the antibiotic and placebo/no antibiotic groups (RR 0·89, 95 per cent c.i. 0·65 to 1·23; P = 0·49). Subgroup analysis of the five double-blind randomized clinical trials (864 patients) again found no difference in infection rates (RR 0·66, 0·36 to 1·21; P = 0·18).
  
  
  CONCLUSIONS
  There was moderate-quality evidence that routine use of antibiotics does not reduce the infection rate in simple hand wounds that require surgery.
authors.affiliation: St Hugh's College, University of Oxford, Oxford, UK.
authors.forename: G R F
authors.identifier: http://orcid.org/0000-0001-9653-2527
authors.initials: GR
authors.lastname: Murphy
authors.affiliation: Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Gardiner
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Glass
authors.affiliation: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
authors.forename: I A
authors.initials: IA
authors.lastname: Kreis
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.|Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hettiaratchy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D015233:Models, Statistical; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents