非手术面部创伤中的抗生素管理：必要还是不必？

文献信息

中文摘要

目的： 闭合性面部骨折常见，且常采用非手术治疗。由于感染率低且抗生素可能造成伤害，常规全身抗生素预防存在争议。我们评估了预防性抗生素是否能减少闭合性、非手术面部骨折的感染性并发症。
方法： 对闭合性、非手术面部骨折的成人（急诊科、住院、重症监护病房）进行了系统综述。检索了PubMed、Scopus和Google Scholar，从建库至2025年9月19日。研究比较了全身预防性抗生素与不使用，和/或≤24小时与>24小时。
结果： 七项美国研究共3274例患者符合纳入标准。各研究中，骨折相关感染率均较低，且预防性抗生素并未降低感染率。在最大的前瞻性多中心队列中，Mian等人报告30天面部骨折相关感染率为1.0%，与不使用预防性抗生素相比，≤24小时或>24小时预防均无显著获益（调整后比值比1.24-1.32）。眶骨和颧骨队列报告，无论采用何种预防策略，均无感染性并发症。在累及鼻窦和重症监护病房队列中，骨折部位感染和鼻窦炎罕见；大多数感染事件为肺炎或呼吸机相关性肺炎，而非面部骨折特异性感染。较长时间抗生素暴露与个别艰难梭菌结肠炎病例相关。
结论： 现有证据不支持对无并发症的闭合性、非手术面部骨折进行常规全身预防性抗生素。最强推断适用于无其他抗生素使用指征的患者。当前数据未能确定预防性抗生素可改善预后的骨折特异性亚组；因此，管理应强调局部护理、复诊警示和结构化随访。

英文摘要

OBJECTIVE: Closed facial fractures are common and often treated nonoperatively. Routine systemic antibiotic prophylaxis is controversial because infection rates are low and antibiotics can cause harm. We assessed whether prophylactic antibiotics reduce infectious complications in closed, nonoperative facial fractures.
METHODS: A systematic review was conducted of adults with closed, nonoperative facial fractures (emergency department, inpatient, intensive care unit). PubMed, Scopus, and Google Scholar were searched from inception through September 19, 2025. Studies compared systemic prophylaxis versus none and/or ≤24 hours versus >24 hours.
RESULTS: Seven US studies comprising 3274 patients met the inclusion criteria. Across studies, fracture-related infection rates were low and were not reduced by prophylactic antibiotics. In the largest prospective multicenter cohort, Mian et al reported a 30-day facial fracture-associated infection rate of 1.0%, with no significant benefit for ≤24 hours or >24 hours of prophylaxis compared with none (adjusted odds ratio 1.24-1.32). Orbital and zygomatic cohorts reported no infectious complications regardless of prophylaxis strategy. In sinus-involving and intensive care unit cohorts, fracture-site infection and sinusitis were rare; most infectious events were pneumonia or ventilator-associated pneumonia rather than facial fracture-specific infections. Longer antibiotic exposure was associated with isolated cases of Clostridioides difficile colitis.
CONCLUSIONS: Available evidence does not support routine systemic prophylaxis for uncomplicated closed, nonoperative facial fractures. The strongest inference applies to patients without another indication for antibiotics. Current data do not identify fracture-specific subgroups in whom prophylaxis improves outcomes; accordingly, management should emphasize local care, return precautions, and structured follow-up.