title: Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial Randomization Tests [Cost effectiveness of preventive antibiotic administration for lowering risk of infection by 0.25%].
abstract: BACKGROUND The efficacy of prophylactic antibiotics in fracture surgery remains controversial for lack of well-documented prospect i ve studies . We report here the findings of the Dutch Trauma Trial , a prospect i ve , r and omised , double-blind , placebo-controlled study of antibiotic prophylaxis in the primary operative treatment of limb fractures .  Ceftriaxone was chosen because of its pharmacokinetic profile , including high serum levels , high tissue penetration , and long elimination half-life , makes it suitable for single-dose prophylaxis . METHODS Patients aged 18 years or more , attending one of fourteen Dutch centres for acute treatment of closed fractures , were r and omly allocated to a single preoperative dose of ceftriaxone 2 g or placebo , and evaluated for development of wound infection and nosocomial infection at 10 days , 30 days , and 120 days . To assess the effects of drop-outs and withdrawals , best-case and worst-case analyses were performed . FINDINGS A total of 2195 patients were included . The incidence of superficial and deep wound infections after placebo was 8.3 % , compared with 3.6 % in the ceftriaxone group ( p < 0.001 , Pearson chi 2-test ) . The rate of nosocomial infection in the first month was 10.2 % with placebo and 2.3 % with ceftriaxone ( p < 0.001 , Pearson chi 2-test ) . Gram-positive bacteria were found in 74.5 % of wound infections and 13.4 % of nosocomial infections . INTERPRETATION Adequate single-dose prophylaxis with a long-acting broad-spectrum antibiotic substantially reduces the incidence of wound infection and early nosocomial infection after surgery for closed fractures Every word to utter from the writer involves the element of this life . The writer really shows how the simple words can maximize how the impression of this book is uttered directly for the readers . Even you have known about the content of r and omization tests so much , you can easily do it for your better connection . In delivering the presence of the book concept , you can find out the boo site here Antibiotic prophylaxis in closed fractures is cost-effective if the risk of a deep infection is reduced by 0.25 % . This control study was undertaken to assess the cost-effectiveness of prophylaxis of postoperative infections after surgical  treatment of closed fractures . The costs for 16 patients with infections ( 8 with deep infections , 8 with superficial infections ) were investigated and compared with the costs for 16 similar but non-infected patients with special reference to length of hospital stay , antibiotics and surgery . The data were collected from the trauma department of the University Hospital of the Free University in Amsterdam .  Costs in the group of 8 patients with superficial wound infection were not substantially higher than those for their non-infected controls . The occurrence of a deep infection meant costs an average of DFL 35,224 higher than an uneventful postoperative course . On the basis of these results , antibiotic prophylaxis of postoperative wound infections is cost-effective if it reduces the risk of deep wound infections by about 0.25 %
target: However , there was no real evidence supporting the second hypothesis that the relative risk of wound infection would substantially vary over different levels of surgery cleanliness .
  : As well as antibiotic prophylaxis being a generally effective intervention for preventing postoperative wound infection , the level of this effectiveness would appear to be reasonably independent of what type of surgery is being considered .
  In particular , perhaps a sensible philosophy would be to assume that antibiotic prophylaxis is effective in reducing the risk of wound infection for all types of surgery , even ones where no clinical trial data exists and make exceptions to this rule if , for certain types of surgery , it can be proved to the contrary
background: CONTEXT While the main focus of a meta- analysis is often to assess the effectiveness of a particular intervention in managing or curing a specific condition , there exists a substantial amount of information within published systematic review s that could be used to assess the validity of a generic hypothesis about the effectiveness of an intervention across a range of different but related conditions .
  OBJECTIVE To systematic ally search for and then collate the results of meta-analyses for the effectiveness of antibiotic prophylaxis in preventing postoperative wound infection across various types of surgery in order to assess generic hypotheses about the effectiveness of this intervention in surgery as a whole .
  With the relative risk of wound infection used as the measure of clinical effectiveness , the hypotheses to be assessed were first that antibiotic prophylaxis would be an effective intervention for preventing wound infection over a broad range of different surgical procedures , and second that there would be a substantial difference in the effectiveness of antibiotic prophylaxis between " clean " and " contaminated " surgical procedures .