Surgical Site Infections in Patients With Type 3 Open Fractures: Comparing Antibiotic Prophylaxis With Cefazolin Plus Gentamicin Versus Piperacillin/Tazobactam

Redfern, Jenessa; Wasilko, Scott M.; Groth, Meghan E.; McMillian, Wesley D.; Bartlett, Craig S.

doi:10.1097/bot.0000000000000554

Cited by 49 publications

(20 citation statements)

References 25 publications

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“…Redfern et al. compared a combination of cefazolin and gentamicin with piperacillin/tazobactam in G–A type III fractures [ 26 ]. They reported that there was no significant difference between treatments and the rate of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, we could not evaluate contamination of the wound quantitatively. Previous studies have reported that a contaminated wound increases the deep infection rate [ 25 , 26 , 33 ]. Nevertheless, there are no standard criteria for determining whether a wound is severely contaminated with mud, sand, or seawater; therefore, additional experimentation is needed in the future to evaluate these criteria.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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Background: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. Materials and methods: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. Results: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). Conclusion: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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“…Rupp et al advocated the use of additional gram-negative antibiotic coverage for Gustilo-Anderson type III fractures and high dose penicillin prophylaxis if faecal or clostridia contamination is suspected [10]. However, prophylaxis with piperacillin/tazobactam showed no inferior results compared to the combined use of cephalosporin and gentamicin for Gustilo-Anderson type III open fractures with regard to surgical site infections after 30 days, fracture non-union, re-hospitalization rates or deaths at one year [11].…”

Section: Discussionmentioning

confidence: 99%

An audit on open tibia fracture management at a tertiary level ortho-plastic center in Sri Lanka: are we following current guidelines?

Kuruwitaarachchi¹,

Mathangasinghe²,

Munidasa³

2021

Sri Lanka j Surg

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IntroductionDespite the availability of guidelines for the surgical management of open tibia fractures set out by developed countries, the adherence of the surgical teams to current recommendations is explored sparsely in resource-poor surgical settings. Here, we report current practice and orthoplastic care gaps at managing open tibia fractures at the National Hospital of Sri Lanka [NHSL]. Methods An audit was conducted on patients with open tibia fracturespresenting to the NHSL. We explored if the ortho-plastic management practices adhere to the recommendations of the standard international guidelines. Results Thirtypatients with compound fractures of the tibia were analyzed. The majority [n=12, 40%] had Gustilo-Anderson type 2 injuries. The median time of presentation from the injury was 2h [IQR=2.5h]. Only 50% of the patients received the first dose of antibiotics within three hours of injury. Initial wound debridement was conducted after a median time of 4.5h [IQR=2.2h] after admission. Only 16.6% of procedures liaised with the plastic surgical team. The median flap cover time was 10 [IQR=4] days. None of the patients underwent simultaneous internal fixation and soft tissue cover by orthopaedic interventions. ConclusionsTimely antibiotic prophylaxis for open tibia fractures was achieved only in 50% of the patients due to late presentation. There were divergences from the current recommendations in the timing of soft tissue debridement and simultaneous orthoplastic interventions, probably due to limited facilities, theatre time and relatively high patient load. We recommend strengthening ortho-plastic approaches and developing

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“…24, 36 With the aim of avoiding some of the complications of aminoglycocides, more recent studies have explored the use of alternative gram-negative coverage. Ceftriaxone 38 , piperacillin/tazobactam 39 , cefotaxime 40 , and cefepime 41 have all been investigated and been found to be either superior or no less effective. The addition of penicillin for fecal or potential clostridial contamination is also recommended.…”

Section: Subsequent Debridements and Medical Managementmentioning

confidence: 99%

Critical-Sized Bone Defects: Sequence and Planning

Toogood

Miclau

2017

Journal of Orthopaedic Trauma

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Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied. The need for subsequent debridements remains a clinical judgement, but all non-viable tissue should be removed prior to definitive coverage. Cefazolin remains the standard of care for all open fractures, and type III injuries also require gram-negative coverage. Both the induced membrane technique (IMT) with staged bone grafting and distraction ostogenesis (DO) are excellent options for bony reconstruction. Soft tissue coverage within one week of injury appears critical.

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Surgical Site Infections in Patients With Type 3 Open Fractures: Comparing Antibiotic Prophylaxis With Cefazolin Plus Gentamicin Versus Piperacillin/Tazobactam

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

Cited by 49 publications

References 25 publications

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

An audit on open tibia fracture management at a tertiary level ortho-plastic center in Sri Lanka: are we following current guidelines?

Critical-Sized Bone Defects: Sequence and Planning

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