Antimicrobial Strategies for Open Depressed Skull Fractures: A 60-Year Scoping Review and Path Forward
Year: 2026
Type: review
Study design: Systematic Review
Abstract: Open depressed skull fractures (DSFs) carry a high risk of intracranial sepsis, yet antimicrobial prophylaxis lacks standardized protocols. This scoping review synthesizes 60 years of evidence to map regimen variability, assess evidence quality, and propose strategies for reducing sepsis through targeted antimicrobial use and stewardship. Following PRISMA-ScR guidelines, we searched PubMed, Scopus, Embase, Web of Science, AANS abstracts, and ClinicalTrials.gov (1965–2025) for studies on open DSFs with sample sizes >20, focusing on antibiotic regimens and infection outcomes. Data on agents, dosage, timing, duration, and sepsis rates were extracted. Study quality was assessed using the Newcastle–Ottawa Scale and Cochrane Risk of Bias Tool. Heterogeneity was evaluated to determine the meta-analysis feasibility. Of 1,286 records, 46 studies were included, with 90% retrospective and Newcastle–Ottawa scores of 3–7 out of 9. Only 28% reported dosage, 19% timing, and none used standardized protocols. Infection rates were 8.5% (95% confidence interval [CI]: 6.2–10.8) for single-agent and 6.8% (95% CI: 4.9–8.7) for multi-agent regimens. High heterogeneity ( I 2 > 75%) precluded meta-analysis. Terminological ambiguity (e.g., prophylaxis vs. preemptive treatment) further complicated evidence synthesis. Persistent variability and poor reporting in DSF antimicrobial prophylaxis underscore the need for standardized protocols and precise terminology. Prospective trials and stewardship-focused guidelines are critical to reduce sepsis and optimize outcomes.
Source: Neurotrauma Reports
Authors: Ruan Grobler, Zandre Calitz, Adriaan J. Vlok
Institutions: University of Toronto, Stellenbosch University
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,750
OpenAlex ID: W7213877959