Effects of Antibiotic Prophylaxis in Patients with Open Fracture of the Extremities

Chang, Yaping; Kennedy, Sean A.; Bhandari, Mohit; Lopes, Luciane Cruz; Bergamaschi, Cristiane de Cássia; Silva, Maria Carolina de Oliveira e; Bhatnagar, Neera; Mousavi, Saeed; Khurshid, Saqib; Petrisor, Brad; Ren, Melody; Sodhi, Sukhmani; Mirza, Reza; Guyatt, Gordon

doi:10.2106/jbjs.rvw.n.00088

Cited by 51 publications

(25 citation statements)

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“… 19 No scientific conclusive data exists in the current literature reporting that the delay in surgical debridement leads to an increase in the incidence of infection. 19 , 20 , 21 , 22 , 23 Further, Ketonis et al and Schenker et al in their reviews have mentioned that there exists a correlation between early administrations of antibiotics with decreased infection rates, which corresponds with the results of the present study with the increased infection rates in 2020 for the same time duration when compared with the infection rates of the previous year, as besides the delay in the surgical intervention from the time of admission, there was a delay in the presentation to the emergency room/delay in the administration of the intravenous antibiotics. 21 , 22 In-addition, there was increase in the readmission rates for the same time period in comparison to the previous year further corroborating the results.…”

Section: Discussionmentioning

confidence: 99%

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Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Gupta

Singhal

Kapoor

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Open fractures form one of the most common musculoskeletal injuries and are often complicated by infection. In this unprecedented situation, the additional infection rates, further add to the burden of the already compromised healthcare setup. The present study is done to see the effect of COVID-19 on management of open fractures. Methods: A retrospective evaluation of patients with open fractures from March 25th , 2020 to July 21st , 2020 (group 1) and March 25th , 2019 to July 21st , 2019 (group 2) was performed. These patients were assessed for demographic details, diagnosis, type of surgery, delay from injury to admission, delay from admission to surgery, postoperative hospital stay, acute infection rates, readmission rates and associated injuries. Results: A total of 52 patients with 59 open fractures in 2020 and 89 patients with 101 open fractures in 2019 met the inclusion criteria. The mean age was 34.76 years and 32.74 years in 2020 and 2019 respectively. Road side accidents were predominant in both the groups, comprising of 38 (73.07%) and 67 (75.28%) respectively(n.s.); adult patients were 42 (80.76%) and 79 (88.76%) respectively(n.s.); paediatric patients were 10 (19.23%) and 10 (11.23%) respectively(n.s.); tibia was the most common bone involved, comprising of 14 (23.72%) and 27 (26.73%) open fractures respectively(n.s.); external fixator was the most commonly used implant during COVID-19 time with 42 (71.18%) and 51 (50.49%) respectively(p ¼ 0.005); the infection rate was 25.42% and 20.79% respectively(n.s.); the time for administration of first intravenous antibiotic dose was on 6.75 h and 4.04 h respectively(p < 0.0001); average time between the admission and surgical debridement was 24.04 h and 19.32 h respectively(n.s.); referral cases were 33 (63.46%) and 44 (49.43%) respectively(n.s.); re-admission rates were 7/52 (13.46%) and 10/89(11.23%) respectively(n.s.). Conclusion: Despite the decrease in total trauma cases, a delay in presentation to the emergency room/ administration of first dose of antibiotic and increase in temporary fixation in form of external fixator was observed. Further, an increase in infection rates, referral cases and readmission rates were observed, though not statistically significant.

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Section: Discussionmentioning

confidence: 99%

“…Also, increased infection rates were found in the Gustilo Anderson classification open grade 3 types in both the years for the same time period, corresponding to the previously mentioned results in the literature. 19 , 20 , 21 , 22 , 23 , 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Gupta

Singhal

Kapoor

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…To address risk of bias we used a modified version of the Cochrane risk of bias tool for randomised trials. 23 24 25 26 We assessed the generation for random sequence; concealment for allocation sequence; blinding of participants, healthcare providers, data collectors, and outcome assessors or adjudicators, or both; incomplete outcome data (missing or lost to follow-up) (we judged low risk of bias if the rate of missing data was lower than 10%); and other potential sources of bias (ie, early trial discontinuation).…”

Section: Methodsmentioning

confidence: 99%

Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis

Qin

Tampi

O’Donnell

et al. 2018

BMJ

120

105

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ObjectiveTo assess the effectiveness and safety of dual agent antiplatelet therapy combining clopidogrel and aspirin to prevent recurrent thrombotic and bleeding events compared with aspirin alone in patients with acute minor ischaemic stroke or transient ischaemic attack (TIA).DesignSystematic review and meta-analysis of randomised, placebo controlled trials.Data sourcesMedline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ClinicalTrials.gov, WHO website, PsycINFO, and grey literature up to 4 July 2018.Eligibility criteria for selecting studies and methodsTwo reviewers independently screened potentially eligible studies according to predefined selection criteria and assessed the risk of bias using a modified version of the Cochrane risk of bias tool. A third team member reviewed all final decisions, and the team resolved disagreements through discussion. When reports omitted data that were considered important, clarification and additional information was sought from the authors. The analysis was conducted in RevMan 5.3 and MAGICapp based on GRADE methodology.ResultsThree eligible trials involving 10 447 participants were identified. Compared with aspirin alone, dual antiplatelet therapy with clopidogrel and aspirin that was started within 24 hours of symptom onset reduced the risk of non-fatal recurrent stroke (relative risk 0.70, 95% confidence interval 0.61 to 0.80, I2=0%, absolute risk reduction 1.9%, high quality evidence), without apparent impact on all cause mortality (1.27, 0.73 to 2.23, I2=0%, moderate quality evidence) but with a likely increase in moderate or severe extracranial bleeding (1.71, 0.92 to 3.20, I2=32%, absolute risk increase 0.2%, moderate quality evidence). Most stroke events, and the separation in incidence curves between dual and single therapy arms, occurred within 10 days of randomisation; any benefit after 21 days is extremely unlikely.ConclusionsDual antiplatelet therapy with clopidogrel and aspirin given within 24 hours after high risk TIA or minor ischaemic stroke reduces subsequent stroke by about 20 in 1000 population, with a possible increase in moderate to severe bleeding of 2 per 1000 population. Discontinuation of dual antiplatelet therapy within 21 days, and possibly as early as 10 days, of initiation is likely to maximise benefit and minimise harms.

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“…Antibiotic resistance is spreading all over the world and its threat has been announced by The World Health Organization (WHO) [15]. For this reason, specific antimicrobial regimens are suggest ed by different guidelines, applied in several hospitals in various countries [16].…”

Section: Discussionmentioning

confidence: 99%

Immediate vs. delayed toe-to-thumb transfer: Is the infection rate greater?

Ornelli

Giovanni

Kaciulyte

et al. 2019

Handchir Mikrochir plast Chir

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Background After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence. Patients and Methods From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection. Results 29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes. Conclusion For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.

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Effects of Antibiotic Prophylaxis in Patients with Open Fracture of the Extremities

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

Cited by 51 publications

References 42 publications

Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis

Immediate vs. delayed toe-to-thumb transfer: Is the infection rate greater?

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