Adherence to Antibiotic Recommendations and Infection Among Patients With Open Long-Bone Fractures: An Examination of Antibiotic Prioritization in Fracture Management

Abstract

Open fractures are at high risk of infection because of exposure of bone and tissue to the environment. Initiation of intravenous antibiotics is recommended within 1 hour of hospital arrival, although the presence of other severe injuries may lead to delays in fracture management. This retrospective study of adult patients with open long-bone fractures admitted to six level 1 trauma centers between January 1, 2018, and December 31, 2019, aimed to examine adherence to antibiotic recommendations. Associations between receiving recommendation-adherent antibiotics and patient and injury characteristics were investigated univariately and in adjusted regression analyses. The most common fracture locations among the 404 patients included were the tibia (43%) and fibula (26%). Fifty-eight percent of patients received recommendation-adherent antibiotics. After adjustment, patient demographics, comorbidities, cause of injury, and overall injury severity did not show significant associations with adherence to recommendations. Concomitant serious abdominal (adjusted odds ratio [AOR]=0.44) and spinal injuries (AOR=0.23) were associated with lower odds of receiving recommendation-adherent antibiotics. Additionally, fractures of certain locations were associated with increased odds of adherence (humerus: AOR=2.78; fibula: AOR=1.64), as were type 3 fractures (AOR=1.55). The overall infection rate was 4%, and adherence to antibiotic recommendations was not associated with infection (3% vs 5% for nonadherent, P =.34). Results suggest that although full recommendation adherence was somewhat low among this patient population, certain injury characteristics were predictive of adherence rates. Current antibiotic recommendations may benefit from consideration of how antibiotic initiation may fit into the prioritization of injury management, especially in patients with polytrauma with other severe injuries. [ Orthopedics . 2023;46(1):54–58.]

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta‐analysis

“…If not handled properly, it may lead to complications such as systemic infection, non‐union of fractures, delayed healing, amputation, prolonged course of disease and limb dysfunction 4–6 . Despite advances in medical technologies such as debridement, irrigation, antibiotics and surgical treatment, the postoperative infection rate of open fractures worldwide still reaches up to 30% 7 . Therefore, how to reduce the occurrence of wound infection and complications of open fractures and promote wound healing has always been a hot topic in trauma orthopaedic research.…”

“…[4][5][6] Despite advances in medical technologies such as debridement, irrigation, antibiotics and surgical treatment, the postoperative infection rate of open fractures worldwide still reaches up to 30%. 7 Therefore, how to reduce the occurrence of wound infection and complications of open fractures and promote wound healing has always been a hot topic in trauma orthopaedic research. With the improvement of modern medical technology and the continuous improvement of treatment methods, negative pressure wound therapy (NPWT) as a new treatment method has gradually been widely used in fractures, chronic non-healing wounds, diabetic feet and infected wounds, and has achieved good results.…”

“… 4 , 5 , 6 Despite advances in medical technologies such as debridement, irrigation, antibiotics and surgical treatment, the postoperative infection rate of open fractures worldwide still reaches up to 30%. 7 Therefore, how to reduce the occurrence of wound infection and complications of open fractures and promote wound healing has always been a hot topic in trauma orthopaedic research.…”