Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center

Johnson, Joey P.; Goodman, Avi D.; Haag, Adam; Hayda, Roman A.

doi:10.1097/bot.0000000000000928

Cited by 17 publications

(21 citation statements)

References 15 publications

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“…To address this issue, an educational campaign could be implemented with the Emergency Department staff that reiterates the importance of hospital protocols regarding antibiotic administration in open fractures. This formal education has proven effective in reducing time to antibiotics in other institutions [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging

et al. 2018

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BackgroundRecent literature has demonstrated that emergent administration of antibiotics is perhaps more critical than even emergent debridement. Most recent studies recommend patients receive antibiotics no later than 1 hour after injury to prevent infection. The objective of this study is to evaluate the time to antibiotic administration after patients with open fractures arrive to a trauma center depending on triaging team.MethodsA retrospective study at a level 1 Trauma center from January 2013 to March 2015 where 117 patients with open fractures were evaluated. Patients who presented with open fractures of the extremities or pelvis were considered. Subjects were identified using Current Procedural Terminology (CPT) codes. Patients aged 18 and older were analyzed for Gustilo type, antibiotics administered in the emergency room (ER), presence of an antibiotic allergy, post-operative antibiotic regimen and number of debridements, among others. Additionally, whether a patient was triaged by ER doctors or trauma surgeons (and made a trauma activation) was evaluated. Outcome measurements included time to intravenous (IV) antibiotic administration and time to surgical debridement.ResultsPatients received IV cefazolin a median of 17 minutes after arrival. Eighty-five patients who were made trauma activations received cefazolin 14 minutes after arrival while 24 non-trauma patients received cefazolin 53 minutes after arrival (p = <0.0001). The median time to gentamicin administration for all patients was 180 minutes. Patients not upgraded to a trauma received gentamicin 263 minutes after arrival, while patients upgraded received gentamicin 176 minutes after arrival. There was no statistically significant difference between the timing to cefazolin or gentamicin based on Gustilo type.ConclusionsOverall, patients that arrive at our institution with open fractures receive IV cefazolin significantly faster when trauma surgeons evaluate the patient. Additionally, delays in gentamicin administration are demonstrated in both triaging groups. This is due to the fact that cefazolin is stocked in the hospital ER, while gentamicin is commonly not due to weight-based dosing requirements precluding a standard dose. Improvements can be made to antibiotic administration of non-trauma patients and those requiring gentamicin via improved education and awareness of open fractures.

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Section: Discussionmentioning

confidence: 99%

Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging

et al. 2018

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“…Contudo, não existe consenso na literatura que suporte tal prática, sendo que muitos dos autores administram de forma empírica, gerando discussões no que tange a resistência antimicrobiana. Embora o tempo para antibióticos para tratar a infecção seja um determinante bem conhecido dos resultados em outros campos da medicina, apenas recentemente o tempo para profilaxia com antibióticos para fraturas expostas foi demonstrado como um fator chave na prevenção da infecção e a diminuição do tempo para a profilaxia com antibióticos na admissão pode ajudar a melhorar os resultados após fraturas expostas 19 .…”

Section: Discussionunclassified

“…Acreditamos que os serviços de residência médica em Ortopedia e Traumatologia devem buscar protocolos e diretrizes a fim de otimizar o protocolo de atendimento de fraturas expostas, como observado no estudo realizado em 2017 por Jonhson et al 19 , que implementou um protocolo reduzindo o tempo entre a admissão e a administração de antibióticos, reduzindo este intervalo em 87,4 minutos (p = 0,0003). Além disso, antes da instituição do protocolo, 46% dos pacientes com fraturas expostas receberam antibióticos dentro de 60 minutos da admissão; após a instituição do protocolo, 84% dos pacientes com fraturas expostas receberam antibióticos dentro de 60 minutos da admissão.…”

Section: Discussionunclassified

Manejo de Fraturas Expostas decorrentes de Traumas: Revisão de Literatura

et al. 2022

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Introdução: Apesar dos avanços realizados no tratamento de fraturas e na prevenção de infecções, as fraturas expostas continuam sendo um desafio terapêutico com níveis variados de evidência para apoiar algumas das práticas mais usadas. Objetivo: Sintetizar as condutas terapêuticas para fraturas expostas causadas por traumas a partir de estudos publicados em base de dados. Métodos: revisão de literatura nas bases de dados MEDLINE, PUBMED, LILACS e SciELO, de artigos provenientes de estudos desenvolvidos nesta temática, publicados entre 2015 e 2019, em inglês, português ou espanhol. Ao final, foram incluídos 10 artigos. Resultados: nove artigos abordaram a antibioticoprofilaxia e a classe antimicrobiana utilizada, tempo de duração e espectro de ação. Cinco estudos abordaram o tempo até o desbridamento e a fixação externa da fratura de acordo com o grau de lesão. Conclusão: conclui-se que o antibiótico deve ser iniciado profilaticamente de forma precoce, preferindo-se o uso de cefalosporinas, com tempo variável de acordo com o grau da exposição. O tempo ideal de desbridamento não deve exceder 48 horas após a lesão, sendo preferencialmente realizado dentro de 6 horas.

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“…It is imperative to prescribe antibiotic prophylaxis as soon as possible [16,17] because early antibiotics diminish infection rates in open fractures [17][18][19]. This is one of the easiest factors to improve in order to optimize the open fracture management in our clinical practice [20]. The British Orthopedic Association recommends to administering antibiotics within 3 h from the injury.…”

Section: Classificationmentioning

confidence: 99%

Management of Open Fracture

Jorge-Mora¹,

Amhaz-Escanlar²,

González³

et al. 2018

Trauma Surgery

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Open fractures are common and their prevalence is increasing in elderly people. The burden of open fractures is high because of economic and social costs. Most open fractures occur in lower limbs. The use of validated protocols, will optimize our outcomes when treating open fractures. The first step began with the proper identification of the fracture characteristics and the hidden soft tissue injury. The use of an adequate and early antibiotic prophylaxis is mandatory and then, we have to perform adequate irrigation and debridement. Finally, we have to decide to temporally fix the fracture or proceed with the definitive fixation method. Recently, the creation of dedicated "orthoplastic" units has increased the outcomes in high-energy tibial fractures. These fractures should be managed in adequate trauma centers that should be used to face all the complications that will appear during the reconstruction procedure because complications can be as high as 50% in high-energy open fractures.

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Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 17 publications

References 15 publications

Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging

Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging

Manejo de Fraturas Expostas decorrentes de Traumas: Revisão de Literatura

Management of Open Fracture

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