Timing of First Systemic Antibiotic Administration and Risk of Deep Infection in Adults with Open Long-Bone Fractures: A Systematic Review and Threshold-Specific Evidence Synthesis

Background/Objectives: Early systemic antibiotics are central to open-fracture care, but a 60 min operational target does not establish a biological infection threshold. We examined how time origin, cutoff, and outcome definition affect interpretation of reported associations.

Methods

Evidence was reconstructed from two preserved bibliographic inventories containing 24 entries. Complete database-search exports were unavailable, and selection, extraction, ROBINS-E, and GRADE were not independently duplicated. The protocol was archived retrospectively on OSF (doi:10.17605/OSF.IO/7J8QN). Estimates were described separately by time origin, cutoff, adjustment, outcome, and follow-up for a target population aged at least 18 years. No pooled estimate was retained.