title: The effect of timing of antibiotic delivery on infection rates related to open limb fractures: a systematic review.
abstract: OBJECTIVE
  To examine whether the timing of delivery of intravenous antibiotics following open limb fractures has an effect on deep infection rates and other outcomes.
  
  
  METHODS
  We published an a priori study protocol in PROSPERO. Our search strategy combined terms for antibiotics, timing of administration and fractures. Two independent reviewers screened, selected, assessed quality and extracted data from identified studies.
  
  
  METHODS
  We searched five electronic databases with no limits and performed grey literature searches.
  
  
  METHODS
  Randomised and non-randomised controlled studies, prospective and retrospective observational studies in which the effect of the timing of delivery of antibiotics on the outcome of deep infection in open fractures was considered were included.
  
  
  RESULTS
  Eight studies were included according to the above criteria. There were no randomised or non-randomised controlled trials. None of the included studies provided data on patient reported or health-related quality of life. The overall deep infection rate ranged from 5% to 17.5%. All of the studies were at substantial risk of bias. One study reported a reduced infection rate with the delivery of antibiotics within 66 min of injury and seven studies reporting no effect.
  
  
  CONCLUSIONS
  Sufficiently robust evidence is not available currently to determine whether the timing of delivery of intravenous antibiotics has an effect on the risk of deep infection or other outcomes following open limb fractures. There is therefore a need for a randomised controlled trial in this area before policy changes should be instigated.
  
  
  BACKGROUND
  PROSPERO (CRD42015016729).
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.|Department of Trauma and Orthopaedics, Avon Orthopaedic Centre, Bristol, UK.
authors.forename: Michael R
authors.identifier: http://orcid.org/0000-0003-2436-9024
authors.initials: MR
authors.lastname: Whitehouse
authors.affiliation: York Trials Unit, Department of Health Sciences, University of York, York, UK.
authors.forename: Catriona
authors.initials: C
authors.lastname: McDaid
authors.affiliation: Department of Trauma and Orthopaedics, Avon Orthopaedic Centre, Bristol, UK.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Kelly
authors.affiliation: Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Moran
authors.affiliation: Oxford Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005121:Extremities / Q000293:injuries / Q000382:microbiology / Q000503:physiopathology; D005597:Fractures, Open / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents
keywords: fractures and dislocations; wounds; wounds, infection