Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures

Declercq, Peter; Zalavras, Charalampos G.; Nijssen, A; Mertens, Beatrijs; Mesure, Julie; Quintens, Jorien; Ridder, Thomas De; Belmans, Ann; Nijs, Stefaan; Spriet, Isabel; Metsemakers, Willem‐Jan

doi:10.1007/s00402-020-03474-8

Cited by 14 publications

(25 citation statements)

References 30 publications

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“…This is similar, in principle, to that published for FRI, 15 which has been adopted by the 2018 ICM 16 and used successfully in recent studies. 17 …”

Section: Resultsmentioning

confidence: 99%

The EBJIS definition of periprosthetic joint infection

McNally

Sousa

Wouthuyzen-Bakker

et al. 2021

The Bone & Joint Journal

375

300

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Aims The diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition. Methods This paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance. Results This process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI. Conclusion The definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice. Cite this article: Bone Joint J 2021;103-B(1):18–25.

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“…This is similar, in principle, to that published for FRI, 15 which has been adopted by the 2018 ICM 16 and used successfully in recent studies. 17 …”

Section: Resultsmentioning

confidence: 99%

The EBJIS definition of periprosthetic joint infection

McNally

Sousa

Wouthuyzen-Bakker

et al. 2021

The Bone & Joint Journal

375

300

View full text Add to dashboard Cite

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“…The duration of antibiotic prophylaxis after surgical management of orthopedic fractures remains debatable, especially for open fractures classified as GA III due to the lack of randomized controlled clinical trials [ 5 , 18 ]. Gillespie et al in a systematic review demonstrated that the antibiotic prophylaxis in closed fractures is cost-effective for preventing infections; however, the impact on bacterial resistance could not be estimated [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dunkel et al concluded, in a retrospective study that infection following open fractures is related to the extent of tissue damage, but not to the duration of antibiotic prophylaxis and that even for GA grade III fractures, one day of antibiotic administration may be as effective as prolonged prophylaxis [20]. Declerquet et al in a retrospective study, did not find evidence for the prophylactic administration of antimicrobials for more than 72 h in open fractures of long bones [5]. Nevertheless, such studies have limitations and there is a lack of higher quality studies assessing the role of lower duration of prophylactic antibiotics on FRI rates.…”

Section: Discussionmentioning

confidence: 99%

“…High severity trauma with open fractures classified as Gustilo–Anderson (GA) III, affecting lower extremity and smoking are known risk factors for FRI, which can reach infection rates up to 30% [ 2 , 4 ]. Thus, in addition to irrigation, through debridement and cleaning the lesion during fracture stabilization with modern orthopedic implants, the early use of systemic and broad-spectrum prophylactic antibiotics is a decisive factor for the prevention of FRI [ 5 ]. The antimicrobial spectrum remains based upon classic studies of Gustilo et al [ 6 ] It consists of targeting activity against gram-positive bacteria in GA grade I and II open and closed fractures and additional activity against gram-negative bacteria in GA grade III open fractures, despite limited evidence confirming the benefit of this recommendation [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The duration of antibiotic prophylaxis over three days in order to prevent FRI in the presence of osteosynthesis is another controversial topic [ 5 , 12 ]. There is a lack of high-quality studies on the subject and the most recent articles did not show any benefit in terms of extended prophylaxis duration [ 2 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Type of antibiotic but not the duration of prophylaxis correlates with rates of fracture-related infection

Prebianchi

Santos

Dell’Aquila

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose The issue of optimal prophylactic antibiotic administration for closed and open fracture surgeries remains controversial. The purpose of this study was to assess the role of type and duration longer than 48 h of antibiotic prophylaxis on the rates of fracture-related infection (FRI). Methods This is a single-center, prospective observational cohort study carried out with patients undergoing surgery for implants insertion to fracture stability. Risk estimates were calculated on the variables associated with factors for FRI and reported as a prevalence ratio (PR) with respect to the 95% confidence interval (CI). Results Overall, 132 patients were analyzed. The global rate of FRI was 15.9% (21/132), with open and closed fractures accounting for 30.5% (11/36) and 10.4% (10/96), respectively. The FRI rates in patients undergoing orthopedic surgery for fracture stabilization who received prophylactic antibiotic for up to and longer than 48 h were 8.9% and 26.4%, respectively. This difference did not reach statistical significance (prevalence ratio [PR] = 2.6, 95% confidence interval [95% CI]: 0.9–7.3. p = 0.063). Conclusions Duration of antibiotic prophylaxis for surgical orthopedic fractures was not correlated with rates of FRI.

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Introduction to Antibiotic Stewardship Principles for the Perioperative Nurse

Gómez¹,

Domonoske²,

Chang³

2023

AORN Journal

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Since 1942, health care personnel have administered antibiotics in the United States to prevent and treat a variety of infections, including surgical site infections. Bacteria can mutate and develop resistance after frequent and repeated antibiotic exposure, thus limiting the antibiotic's effectiveness. Because antibiotic resistance can be passed from one bacterium to another, antibiotics are the only class of medications where use in one patient may negatively affect clinical outcomes in another. Antibiotic stewardship (AS) focuses on appropriate antibiotic selection, dosing, route, and duration of therapy; it seeks to minimize unplanned consequences, such as resistance and toxicity. Although there is a lack of literature on AS specific to perioperative nurses, general nursing practice includes AS activities (eg, assessing patient allergies, adhering to antibiotic administration recommendations). Perioperative nurses should participate in AS activities and use evidence‐based strategies to communicate effectively with health care team members when advocating for appropriate antibiotic use.

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Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures

Cited by 14 publications

References 30 publications

The EBJIS definition of periprosthetic joint infection

The EBJIS definition of periprosthetic joint infection

Type of antibiotic but not the duration of prophylaxis correlates with rates of fracture-related infection

Introduction to Antibiotic Stewardship Principles for the Perioperative Nurse

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