Antibiotic Prophylaxis in Open and Closed Fractures:<i>A Controlled Clinical Trial</i>

Bergman, Bo

doi:10.3109/17453678208992179

Cited by 47 publications

(36 citation statements)

References 21 publications

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“…In ORIF procedures, the metal implants used for internal fixation and the periprosthetic environment (e.g., biofilm formation) can significantly increase the probability of SSI. For this reason, routine antibiotic prophylaxis has generally been considered the standard of care for ORIF surgeries [3,26]. Prolonged courses of broad-spectrum antibiotics, starting before surgery until suture removal, had been used previously for all patients undergoing ORIF surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…To minimise SSI occurrences, perioperative prophylactic antibiotics have been routinely used for all patients undergoing ORIF procedures. Although it is generally accepted that prophylactic antibiotics are effective in reducing the incidence of SSI in contaminated and dirty wounds [3,5], it remains uncertain whether antibiotics should be used routinely with patients undergoing clean ORIF surgeries who are at low risk of developing SSI [13,17].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Mao

Liu

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Mao

Liu

et al. 2015

Injury

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“…The benefits of prophylactic antibiotic use against Gram positive bacteria have since been supported by other series. [11][12][13] While research supports the benefits of prophylactic antibiotics that target Gram positive bacteria, there is insufficient evidence to support the prophylactic use of Gram negative antibiotics. 9,13,14 As Gram negative bacteria become more prevalent in open fracture infections, including Acinetobacter baumannii and Pseudomonas aeruginosa, research addressing the prophylactic benefits of Gram negative antibiotics will become increasingly important.…”

Section: Discussion Current Concepts In Open Fracture Care and Infectmentioning

confidence: 99%

Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

Hannigan

Pulos

Grice

et al. 2015

Advances in Wound Care

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Significance: Open fractures are fractures in which the bone has violated the skin and soft tissue. Because of their severity, open fractures are associated with complications that can result in increased lengths of hospital stays, multiple operative interventions, and even amputation. One of the factors thought to influence the extent of these complications is exposure and contamination of the open fracture with environmental microorganisms, potentially those that are pathogenic in nature. Recent Advances: Current open fracture care aims to prevent infection by wound classification, prophylactic antibiotic administration, debridement and irrigation, and stable fracture fixation. Critical Issues: Despite these established treatment paradigms, infections and infection-related complications remain a significant clinical burden. To address this, improvements need to be made in our ability to detect bacterial infections, effectively remove wound contamination, eradicate infections, and treat and prevent biofilm formation associated with fracture fixation hardware. Future Directions: Current research is addressing these critical issues. While culture methods are of limited value, culture-independent molecular techniques are being developed to provide informative detection of bacterial contamination and infection. Other advanced contamination-and infection-detecting techniques are also being investigated. New hardware-coating methods are being developed to minimize the risk of biofilm formation in wounds, and immune stimulation techniques are being developed to prevent open fracture infections. SCOPE AND SIGNIFICANCEOpen fractures occur when bone is exposed through skin as a result of bone breaking through skin or wound penetration with fractured bone exposure. While multiple factors may influence open fracture rate, a recent study reported an incidence of 30.7/ 10 5

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“…In 1982, Bergman published a randomized, placebo-controlled series of prophylactic antibiotic use for 180 fractures [55]. The number of open fractures was small (n ϭ 90), however, and included "various" bones.…”

Section: Randomized or Other Prospective (Class I And Ii) Studiesmentioning

confidence: 99%

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

Hauser

Adams

Eachempati

2006

Surgical Infections

220

116

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The data support the conclusion that a short course of first-generation cephalosporins, begun as soon as possible after injury, significantly lowers the risk of infection when used in combination with prompt, modern orthopedic fracture wound management. There is insufficient evidence to support other common management practices, such as prolonged courses or repeated short courses of antibiotics, the use of antibiotic coverage extending to gram-negative bacilli or clostridial species, or the use of local antibiotic therapies such as beads. Large, randomized, blinded trials are needed to prove or disprove the value of these traditional approaches. Such trials should be performed in patients with high-grade fractures who (1) are well-stratified according to the degree of local injury and (2) undergo standardized fracture and wound management. Trials also must be powered to study the effects of extended antibiotic coverage on nosocomial infections. Antibiotic regimens confirmed to improve local fracture outcomes in such studies could then be used rationally, balancing the risks of local fracture-related infections and of multi-drug-resistant systemic infections to achieve optimal global outcomes.

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Antibiotic Prophylaxis in Open and Closed Fractures:A Controlled Clinical Trial

Cited by 47 publications

References 21 publications

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

Prophylactic Antibiotic Use in Open Fractures: An Evidence-Based Guideline

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