Prävention von Infektionen bei offenen Frakturen heute

Grote, Stefan; Polzer, Hans; Prall, Wolf Christian; Gill, Sps; Shafizadeh, Sven; Banerjee, Marc; Bouillon, Bertil; Bäthis, H.

doi:10.1007/s00132-011-1839-x

Cited by 23 publications

(15 citation statements)

References 57 publications

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“…Based on a systematic review of 49 studies, evidenced-based guidelines support early antibiotic coverage of gram positives in all grades of fracture, with addition of gram negative coverage in grade III fractures [30]. Monotherapy with a first generation cephalosporin (e.g.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…Combining a local antibiotic bead pouch with systemic prophylaxis reduced the infection rate significantly over parenteral systemic antibiotics alone [37]. The quality of evidence supporting local antibiotics, however, is low and warrants further study [30, 36, 38]. …”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…It is frequently touted in current practice guidelines, such as those posted by the BOA/BAPRAS [32] or EAST Practice Management Guidelines Work Group [38], as a standard to minimize infection complication risk. A recent systematic review concluded that strong support of “early surgical debridement” existed (within 24 hours) [30]. Basic science studies of wound colonization and bacterial adherence demonstrate a time-dependence of these factors that supports a need for urgency in debridement [42, 43].…”

Section: Timing To the Operating Room (Or)mentioning

confidence: 99%

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Controversies in the Management of Open Fractures

C.L

Menon

N.M

2014

TOORTHJ

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Open fractures are a common problem encountered by orthopaedic surgeons and comprise a broad spectrum of trauma. Management is guided by principle-based steps aimed at reducing the risk of gas gangrene or suppurative infections, whilst maintaining viability in a favourable soft tissue environment to reduce the risk of delayed or non-union of bone. Aspects of these principles, however, create discussion around several areas of controversy. The specific antimicrobial regimen and its duration are questions that have been evaluated for decades. Like the ever-evolving nature of the bacterial pathogens, the answer to this is dynamic and changing. The “six-hour rule” is a hotly debated topic with fervent perseverance of this dogma despite a gross lack of support from the literature. The most appropriate soft tissue management approach for open fractures – immediate definitive soft tissue closure versus leaving wounds open for delayed closure or definitive management – is also an area of debate. Exploration of these controversies and consideration for the historical context of the supporting literature furthers our understanding of the critical elements.

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Section: Antibiotic Prophylaxismentioning

confidence: 99%

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Section: Timing To the Operating Room (Or)mentioning

confidence: 99%

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Controversies in the Management of Open Fractures

C.L

Menon

N.M

2014

TOORTHJ

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“…Ein Überblick über die aktuelle Studienlage wurde von Grote et al [3] veröffentlicht. Richtlinien wurden bisher allein zur Antibiotikabehandlung herausgegeben, die von der East Practice Management Guideline Work Group erstellt wurden [4].…”

Section: Therapie Offener Frakturenunclassified

Toxic-shock-Syndrom nach offener Sprunggelenkverletzung

et al. 2014

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The treatment of open fractures is a challenge for the attending surgeon. Depending on the severity, the risk of infection rises up to 50%. Local infection up to the point of sepsis can develop in spite of surgical and antimicrobial therapy. The present case demonstrates the case of an 18-year-old man who developed toxic shock syndrome (TSS) after an open ankle fracture. This potentially life-threating syndrome usually presents with the main symptoms of fever, hypotension and exanthema and is caused by toxins, such as toxic shock syndrome toxin 1 (TSST-1) and staphylococcal enterotoxins A-D. In some cases it is associated with cardiopulmonary decompensation and can rapidly progress to multiorgan failure.

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“…For the assessment of open fractures, the Gustilo-Anderson classification system was widely used [3]. Depending on severity of the lesion, treatment might include debridement and internal and external fixation in the acute management [4, 5]. The following bacterial infection of bony and soft tissues is a major challenge which might further lead to sepsis, acute or chronic osteomyelitis, delayed union, nonunion, or even loss of the extremity.…”

Section: Introductionmentioning

confidence: 99%

A Descriptive Study of Open Fractures Contaminated by Seawater: Infection, Pathogens, and Antibiotic Resistance

Zhu

Zheng

2017

BioMed Research International

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Aims. In this work, the main objectives were to investigate the clinical characteristics and bacterial spectrum present in open fractures contaminated by seawater. Methods. We conducted a retrospective cohort study and included all patients with open fractures from 1st January, 2012, to 31st December, 2015, in our hospital. Patients were grouped based on the presence of seawater contamination in wounds. We compared the infection rate, bacterial spectrum, and antibiotic resistance between the two groups. Results. We totally included 1337 cases of open fracture. Wounds from 107 cases (8.0%) were contaminated by seawater. The wound infection rate of seawater-contaminated group was significantly higher in patients with Gustilo-Anderson Type II and Type III open fractures. The bacterial spectrum from seawater-contaminated wounds was remarkably different from that of the remaining. Antibiotic sensitivity tests revealed that more than 90% of infecting pathogens in seawater-contaminated wounds were sensitive to levofloxacin and ciprofloxacin. Conclusion. Cephalosporin in combination with quinolone was recommended in the early-stage management of open fractures contaminated by seawater.

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Prävention von Infektionen bei offenen Frakturen heute

Abstract: This evidence-based analysis shows that there is good evidence for the treatment of open fractures with antibiotics and surgical debridement. Vacuum treatment can be recommended if wound closure is not possible.

Cited by 23 publications

References 57 publications

Controversies in the Management of Open Fractures

Controversies in the Management of Open Fractures

Toxic-shock-Syndrom nach offener Sprunggelenkverletzung

A Descriptive Study of Open Fractures Contaminated by Seawater: Infection, Pathogens, and Antibiotic Resistance

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