• Karolina Dahms, Kelly Ansems, Julia Dormann, Eva Steinfeld, Heidrun Janka, Maria-Inti Metzendorf, Thomas Breuer, and Carina Benstoem.
• Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, RWTH Aachen University, Aachen, Germany.
• Eur J Trauma Emerg Surg. 2025 Feb 13; 51 (1): 105105.

PurposeThe use of antibiotic prophylaxis in trauma patients, particularly to prevent ventilator-associated pneumonia (VAP), is debated due to rising antibiotic resistance. Therefore, this systematic review evaluated the safety and effectiveness of antibiotic prophylaxis compared to placebo or standard care on clinical outcomes in adult polytrauma patients.MethodsWe searched PubMed and the Cochrane Central Register of Controlled Trials to identify completed and ongoing studies from database inception to April 20, 2023. Eligible studies included systematic reviews and randomized controlled trials (RCTs) comparing antibiotic prophylaxis to placebo or standard care in adult polytrauma patients admitted to the intensive care unit (ICU).ResultsOf 1237 identified records, three RCTs involving 256 patients (nantibiotics = 176, ncontrol = 165, mean age 37.4 years, 81.6% male) were included. Antibiotic prophylaxis showed little or no effect on all-cause mortality compared to placebo or standard care (RR 1.01, 95% CI 0.55-1.85; RD 2 more per 1000, 95% CI -79 to 150; 2 studies, 209 participants; I2 = 0%; very low certainty of evidence).ConclusionThe results indicate that antibiotic prophylaxis has no significant effect on mortality and clinical status compared with placebo or standard care in adult polytrauma patients but may reduce the risk of VAP. However, the evidence is outdated and of very low certainty, with insufficient data to draw definitive conclusions regarding efficacy. Therefore, high-quality, up-to-date research is urgently needed to support clinical decision-making, and current interpretations should be treated with caution.© 2025. The Author(s).

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