Type III Gustilo–Anderson open fracture does not justify routine prophylactic Gram-negative antibiotic coverage

Abstract

Postoperative surgical site infection (SSI) is common in open long bone fractures, so early administration of prophylactic antibiotics is critical to prevent SSI. However, the necessity of initial broad-spectrum coverage for Gram-positive and -negative pathogens remains unclear. The purpose of this study was to clarify the effectiveness of prophylactic broad-spectrum antibiotics in a large, national-wide sample. We reviewed an open fracture database of prospectively collected data from 111 institutions managed by our society. A retrospective cohort study was designed to compare the rates of deep SSI between narrow- and broad-spectrum antibiotics, which were initiated within three hours after injury. A total of 1041 type III fractures were evaluated at three months after injury. Overall deep SSI rates did not differ significantly between the narrow-spectrum group (43/538, 8.0%) and broad-spectrum group (49/503, 9.8%) (p = 0.320). During propensity score-matched analysis, 425 pairs were analyzed. After matching, no significant difference in the SSI rate was seen between the narrow- and broad-spectrum groups, with 42 SSIs (9.9%) and 40 SSIs (9.4%), respectively (p = 0.816). The probability of deep SSI was not reduced by broad-spectrum antibiotics compared with narrow-spectrum antibiotics in type III open long bone fractures.

Distribution of pathogens and risk factors for post-replantation wound infection in patients with traumatic major limb mutilation

“…Surgical site infections, the most common health care-acquired infections, are associated with the emergence of postoperative infected with multidrug-resistant bacteria [ 7 , 28 – 32 ]. Previous studies reported that the postoperative wound infection rate of GA classification type III can be even as high as 50% or more [ 8 , 11 , 33 ], which is itself associated with higher postoperative wound infection of fractures [ 17 ].…”

“…Reports on etiological characteristics after regrafting of severe traumatic mutilation of major limbs were limited. For patients with type III open fractures, gram-negative bacilli should be covered in addition to gram-positive bacilli, for which the evidence of evidence-based medicine was insufficient [ 7 , 13 , 14 , 22 ]. We here found the main pathogen distribution characteristics, which may provide targeted basis for the use of prophylactic antibiotics in patients in these regional centers.…”

“…This study found that postoperative wound infection was common in patients with severe traumatic major limb mutilation, and most of the pathogenic bacteria were multi-drug resistant bacteria, which was associated with ischemic time, degrees of wound contamination, stress hyperglycemia, and MESS. Surgical site infections, the most common health care-acquired infections, are associated with the emergence of postoperative infected with multidrug-resistant bacteria [7,[28][29][30][31][32]. Previous studies reported that the postoperative wound infection rate of GA classification type III can be even as high as 50% or more [8,11,33], which is itself associated with higher postoperative wound infection of fractures [17].…”

“…With the development of surgical techniques, the limbs saving rate of patients gradually increased [ 1 , 4 ], however, with the aggravation of trauma severity, the incidence of postoperative complications also gradually increased [ 2 , 5 , 6 ]. Postoperative wound infection is one of the most common complications after surgery [ 7 , 8 ]. Studies showed that Gustilo-Anderson (GA) Classification type III was positively associated with the increased of infection and other complications [ 8 , 9 ].…”

A novel primary antibiotic cement-coated locking plate as a temporary fixation for the treatment of open tibial fracture

“…The treatment process was divided into three steps. In the first stage, at the emergency department, intravenous second-generation cephalosporin antibiotics 9 , 10 (cefuroxime) were administered as soon as possible after the patient entered the hospital. Initial debridement of the devitalised and contaminated tissues was performed by a senior doctor using loupe magnification, tourniquet control, and irrigation with 9 L of solution.…”