Antibiotic Prophylaxis in Bacterial Infection of Type IIIA Open Fracture of Tibial ShaftWith orWithout Fibula Fracture

Authors

1 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Orthopedic Research Center,Mashhad University of Medical Sciences,Mashhad, IR Iran

3 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, IR Iran

4 Department of Research and Education, Razavi Hospital, Mashhad, IR Iran

5 Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran

Abstract

 Background: Amajor purpose of treating open fractures is the prevention of wound infection. Infection, as amajor complication associated with open fractures,may lead to limb loss, sepsis, and even death. In this study, we survey factors affecting infection.
 
Objectives: In this study, we survey factors affecting infection.
 
Methods: The study population consisted of all patients with type IIIA gastilo open fractures of tibial shaft, with or without fibula fracture (caused by trauma). Afterwound irrigation, debridement, andwound swab sampling formicrobial culture, all patients received prophylactic antibiotic regimens in fitting with their wound class. No topical antibiotics were used with a 6-month follow-up for any symptomof osteomyelitis.
 
Results: Considering the occurrence of one case of infection, the infection ratewas calculated (1.89%). Given the lowprevalence rate of infection, itwas difficult to evaluate the effect of different antibiotic regimens on the prevention of infection (in terms of regimen duration). As such, no specific regimen was preferred. The results of statistical analysis did not show any significant difference between one-day application of antibiotic prophylaxis and two or three days consumption of antibiotic prophylaxis.
 
Conclusions: According to the results of this study, one-day administration of antibiotics as prophylaxis (first generation of cephalosporins) was sufficient for the prevention of infection after orthopedic surgery in all patients except in patient with risk factors such as diabetes or immune deficiency, when the administration of prophylactic antibiotic lasts for 3 days.

Keywords


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453- 8. [PubMed: 773941].
https://doi.org/10.2106/00004623-197658040-00004
 
2. D'Souza A, Rajagopalan N, Amaravati RS. The use of qualitative cultures for detecting infection in open tibial fractures. J Orthop Surg (Hong Kong). 2008;16(2):175-8. [PubMed: 18725667]. 6 Razavi Int J Med. 2016; 4(2):e37811. Rahimi Shorin H et al.
https://doi.org/10.1177/230949900801600209
PMid:18725667
 
3. Holtom PD, Smith AM. Introduction to adult posttraumatic osteomyelitis of the tibia. Clin Orthop Relat Res. 1999(360):6-13. [PubMed: 10101305].
https://doi.org/10.1097/00003086-199903000-00003
PMid:10101305
 
4. Valenziano CP, Chattar-Cora D, O'Neill A, Hubli EH, Cudjoe EA. Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?. Arch Orthop Trauma Surg. 2002;122(5):259-61. [PubMed: 12070643].
https://doi.org/10.1007/s00402-001-0363-6
PMid:12070643
 
5. Robinson D, On E, Hadas N, Halperin N, Hofman S, Boldur I. Microbiologic flora contaminating open fractures: its significance in the choice of primary antibiotic agents and the likelihood of deep wound infection. J Orthop Trauma. 1989;3(4):283-6. [PubMed: 2600693].
https://doi.org/10.1097/00005131-198912000-00003
PMid:2600693
 
6. Faisham WI, Nordin S, Aidura M. Bacteriological study and its role in the management of open tibial fracture. Med J Malaysia. 2001;56(2):201-6. [PubMed: 11771081].
 
7. Tavakoli M, Davey P, Clift BA, Davies HT. Diagnosis and management of osteomyelitis. Decision analytic and pharmacoeconomic considerations. Pharmacoeconomics. 1999;16(6):627-47. [PubMed: 10724791].
https://doi.org/10.2165/00019053-199916060-00003
PMid:10724791
 
8. Mader JT, Cripps MW, Calhoun JH. Adult posttraumatic osteomyelitis of the tibia. Clin Orthop Relat Res. 1999(360):14-21. [PubMed: 10101306].
https://doi.org/10.1097/00003086-199903000-00004
PMid:10101306
 
9. Seligson D, Klemm K. Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft. Clin Orthop Relat Res. 1999(360):30-6. [PubMed: 10101308].
https://doi.org/10.1097/00003086-199903000-00006
PMid:10101308
 
10. Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res. 1997(339):71-5. [PubMed: 9186203].
https://doi.org/10.1097/00003086-199706000-00010
PMid:9186203
 
11. Kreder HJ, Armstrong P. The significance of perioperative cultures in open pediatric lower-extremity fractures. Clin Orthop Relat Res. 1994(302):206-12. [PubMed: 8168303].
https://doi.org/10.1097/00003086-199405000-00032
 
12. Lingaraj R, Santoshi JA, Devi S, Najimudeen S, Gnanadoss JJ, Kanagasabai R, et al. Predebridement wound culture in open fractures does not predict postoperative wound infection: A pilot study. J Nat Sci Biol Med. 2015;6(Suppl 1):S63-8. [PubMed: 26604622].
https://doi.org/10.4103/0976-9668.166088
PMid:26604622 PMCid:PMC4630766
 
13. Ikem IC, Oginni LM, Bamgboye EA, Ako-Nai AK, Onipede AO. The bacteriology of open fractures in Ile-Ife, Nigeria. Niger J Med. 2004;13(4):359-65. [PubMed: 15523862].
 
14. Lenarz CJ, Watson JT, Moed BR, Israel H, Mullen JD, Macdonald JB. Timing of wound closure in open fractures based on cultures obtained after debridement. J Bone Joint Surg Am. 2010;92(10):1921-6. [PubMed: 20660225].
https://doi.org/10.2106/JBJS.I.00547
PMid:20660225
 
15. Petrisor B, Anderson S, Court-Brown CM. Infection after reamed intramedullary nailing of the tibia: a case series review. J Orthop Trauma. 2005;19(7):437-41. [PubMed: 16056073].
https://doi.org/10.1097/01.bot.0000161542.93624.8d
PMid:16056073
 
16. Yokoyama K, Uchino M, Nakamura K, Ohtsuka H, Suzuki T, Boku T, et al. Risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures. Injury. 2006;37(6):554- 60. [PubMed: 16352306].
https://doi.org/10.1016/j.injury.2005.08.026
PMid:16352306
 
17. Yokoyama K, Itoman M, Shindo M, Kai H, Ueta S, Kobayashi A. Deep infection and fracture healing in immediate and delayed locked intramedullary nailing for open femoral fractures. Orthopedics. 1999;22(5):485-90. [PubMed: 10348109].
 
18. Noumi T, Yokoyama K, Ohtsuka H, Nakamura K, Itoman M. Intramedullary nailing for open fractures of the femoral shaft: evaluation of contributing factors on deep infection and nonunion using multivariate analysis. Injury. 2005;36(9):1085-93. [PubMed: 16054148].
https://doi.org/10.1016/j.injury.2004.09.012
PMid:16054148
 
19. Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87(7):1415-22.[PubMed: 15995106].
https://doi.org/10.2106/00004623-200507000-00001
 
20. Patzakis MJ, Greene N, Holtom P, Shepherd L, Bravos P, Sherman R. Culture results in open wound treatment with muscle transfer for tibial osteomyelitis. Clin Orthop Relat Res. 1999(360):66-70. [PubMed: 10101311].
https://doi.org/10.1097/00003086-199903000-00009
PMid:10101311