Update in Therapeutics: Prophylactic Antibiotics in Open Fractures

Samai, Kathryn; Vilella, Antonia L.

doi:10.1097/jtn.0000000000000348

Cited by 8 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For several years, prevention and controlling infection for open fractures stays the crucial goal in the treatment of these wounds, so different methods were applied to achieve this goal [19,20]. All these methods are depending on utilizing different types of antibiotic regimes [21,22]. ese antibiotic patterns benefit in several cases, but when the causative bacterial agents were multidrug resistance as shown in this study, these methods become ineffective in the treatment of open fracture infections.…”

Section: Discussionmentioning

confidence: 98%

The Novel Role of Healing from Bacterial Infections of Lower Limb Open Fractures by X-Ray Exposure

Mahdi

Al-Salmani

Al-Qaisi

2020

International Journal of Microbiology

View full text Add to dashboard Cite

Introduction. An open fracture refers to a break in the skin, which is exposed to microbial contamination and eventually leads to most complicated infections. X-rays can kill bacteria by causing irreversible DNA damage. Objective. To confirm the role of X-ray exposure in treating infected wound fractures at the lower limb and determine X-ray exposure times. Methods. Fifty-one wound swabs were collected from patients with infected open fractures at the lower limb with grade II, IIIA, B, and C according to the Gustilo and Anderson classification system and then cultured. e bacterial isolates were identified by biochemical tests and the VITEK-2 System and tested against several antibiotics. e X-ray exposure was done for open fractures by radiography (at kV133 and 5 milliambers). Results. e higher isolation rate was recorded for Staphylococcus aureus with 21 (41.2%) isolates, and most of them (20, 95.2%) were isolated from grade II fractures. e isolation rate of Gram-negative bacteria was 25.5% for Escherichia coli with 13 isolates, 19.6% for Pseudomonas aeruginosa with 10 isolates, and 13.7% for Klebsiella pneumoniae with 7 isolates, most of which were isolated from grade III fractures. e isolation rate of P. aeruginosa was 60% (6 isolates) from grade IIIA and 71.4% (5 isolates) from grade IIIB for K. pneumoniae, while for E. coli it was 69.2% (9 isolates) from grade IIIC. All the bacterial isolates recorded high levels of antibiotic resistance against most tested antibiotics. Wound cultures of grade II fractures appeared sterile after the first X-ray exposure, and these wounds were infected with S. aureus or P. aeruginosa. However, cultures of grade IIIA and IIIB fractures appeared sterile after the second X-ray exposure for all isolated bacteria, except for S. aureus (grade IIIA fractures) (after the third X-ray exposure). Grade IIIC fractures showed sterile culture after the third X-ray exposure for wounds infected with P. aeruginosa and E. coli. Conclusions. e study concluded that X-ray exposure showed high effectiveness in treating infected open fractures.

show abstract

Section: Discussionmentioning

confidence: 98%

The Novel Role of Healing from Bacterial Infections of Lower Limb Open Fractures by X-Ray Exposure

Mahdi

Al-Salmani

Al-Qaisi

2020

International Journal of Microbiology

View full text Add to dashboard Cite

show abstract

“…Current literature recommends addition of ampicillin or penicillin antibiotic prophylaxis for farm-related injuries to cover anaerobic organisms, such as Clostridium sp., with little evidence to support this recommendation. 2,5,10,19 Furthermore, there is paucity of literature surrounding the addition of gram-negative organism coverage in open injuries and whether this coverage helps to decrease gram-negative infection rates. This deficiency in orthopaedic literature requires further data and investigation.…”

Section: Discussionmentioning

confidence: 99%

Agricultural Trauma Causing Open Fractures: Is Antibiotic Coverage Against Anaerobic Organisms Indicated?

Wynn

Kesler

Morellato

et al. 2022

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objective: To compare deep infection rate and causative organisms in open fractures of the lower extremity from agricultural trauma with similar injuries in nonagricultural trauma. Design: Retrospective. Setting: Two tertiary care institutions. Methods: Open lower extremity fractures sustained between 2003 and 2018 caused by agriculture-related trauma in adult patients were reviewed. A nonagriculture open fracture control group (NAG) was identified for comparison. Patient demographics and injury characteristics were assessed. Outcomes included occurrence of deep infection and causative organisms.Results: One hundred seventy-eight patients were identified in the agriculture (AG) (n = 89) and control (NAG) (n = 89) groups. Among patients with agricultural injury, farm machinery was the most common mechanism in 69 (77.5%) of them. Open injuries of the foot (38.2%) and tibial shaft injuries (25.8%) were the most common in the AG and NAG groups, respectively. Deep infection was seen in 21% of patients in the AG group compared with 10% in the NAG group (P , 0.05). In the AG group, anaerobic infection occurred in 44% of patients with deep infection compared with 9.1% in the NAG group (P , 0.05). The most common anaerobic organisms included enterococci, Pseudomonas aeruginosa, and Clostridium perfringens.Conclusions: This study supports that open fractures due to agricultural trauma have a high infection rate, with anaerobic infection occurring at higher rates than in injuries due to nonagricultural trauma. Prophylactic treatment with antibiotics directed against anaerobes is indicated in these injuries.

show abstract

“…Postoperative infection, especially in fracture surgery, is a main orthopedic problem that could severely affect the outcome of these operations (10,11). Even though the impact of preventive administration of systemic antibiotics has been proven to prevent infection after the ORIF surgeries (9, 12), contradictory results have been reported regarding the duration of prophylactic antibiotic administration and its effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Prophylactic Antibiotics in Infection Prevention in Closed Lower-Limb Fracture Surgery

Jokar

Esmaeilnejadganji

Bijani

et al. 2022

Preprint

View full text Add to dashboard Cite

Background:‌ Postoperative infection is a major orthopedic problem that can be reduced by prescribing antibiotics to prevent surgical infection as an effective strategy. Therefore, the present study aimed to evaluate the effectiveness of prophylactic antibiotics to prevent infection in closed lower limb fracture surgery. Methods:‌ The present study was conducted on all patients with closed lower limb fracture from hip to the ankle that underwent Open reduction and internal fixation ‌(ORIF)‌ by a surgeon and received antibiotics and prophylactic antibiotics. The patients who received cefazolin prophylactic antibiotics 1 hour before surgery and 24 hours after surgery were put into the first group. Those receiving cefazolin prophylactic antibiotics 1 hour before surgery and up to 72 hours after surgery were put into the second group. It should be noted that the criterion for the presence of infection was the physician’s clinical judgment based on clinical manifestations such as heat, redness and swelling, pain and infectious secretions, and laboratory tests. Results:‌ Of 140 patients with closed lower limb fractures, two patients‌ (1.4%)‌were infected in each group. The culture of two patients with infection resulted in Staphylococcus aureus, and both patients showed fever and chill symptoms. Infection rates in patients, who received prophylactic antibiotics for 24 hours, had no significant difference with those who received antibiotics for 72 hours ‌(p=0.99).Conclusion:‌ Based on the present study results, the 24-hour prophylactic antibiotic administration to reduce risks of postoperative infection of the closed lower limb fracture in patients can be a suitable alternative for the long-term use of antibiotics.

show abstract

Update in Therapeutics: Prophylactic Antibiotics in Open Fractures

Cited by 8 publications

References 14 publications

The Novel Role of Healing from Bacterial Infections of Lower Limb Open Fractures by X-Ray Exposure

The Novel Role of Healing from Bacterial Infections of Lower Limb Open Fractures by X-Ray Exposure

Agricultural Trauma Causing Open Fractures: Is Antibiotic Coverage Against Anaerobic Organisms Indicated?

Effectiveness of Prophylactic Antibiotics in Infection Prevention in Closed Lower-Limb Fracture Surgery

Contact Info

Product

Resources

About