Comment on: Prophylactic antibiotics in hand trauma surgery: a network meta-analysis

Correspondence to: Jiayi Chen (email: cjy13912736738@163.com)

Dachun Road 999

Wujiang District

Suzhou City

215221

China

BJS, https://doi.org/10.1093/bjs/znaf191, published 29 September 2025

I read with great interest the recent network meta-analysis1 evaluating the efficacy of prophylactic antibiotics in hand trauma surgery. The authors provide a much-needed synthesis of evidence in an area where clinical practice often varies widely despite decades of research. Their findings—that prophylactic antibiotics do not clearly reduce surgical site infection (SSI) rates in hand trauma procedures—highlight important implications for both clinical practice and antimicrobial stewardship.

The pooled SSI prevalence of 3.6% across nearly 4000 patients underscores the generally low absolute risk of infection in this surgical population. Although some antibiotic regimens appeared to rank more favourably in indirect comparisons, the confidence intervals were wide and the majority of included studies carried moderate to high risk of bias. These limitations rightly temper any definitive conclusions. Nevertheless, the analysis reinforces existing concerns that routine antibiotic use in these settings may not provide meaningful benefit.

Of particular significance is the authors’ observation that neither injury severity nor operative location meaningfully altered the effect of antibiotics. This challenges long-standing assumptions that more complex injuries or procedures performed outside main theatres require routine prophylaxis. Combined with broader public health concerns surrounding antimicrobial resistance, these findings support a more conservative and evidence-based approach to prescribing.

However, the persistent methodological weaknesses across the literature—especially inconsistent definitions of SSI and short follow-up periods—underscore the urgent need for well-designed randomized controlled trials. Adequately powered, standardized studies that incorporate timely antibiotic administration, clear diagnostic criteria, and meaningful outcome measures are essential before practice guidelines can be confidently refined.

The present meta-analysis contributes valuable clarity to an uncertain field. As clinicians, researchers, and policymakers strive to balance infection prevention with responsible antibiotic use, such work is both timely and necessary.