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Review
. 2023 May 1;13(1):7085.
doi: 10.1038/s41598-023-34142-7.

Type III Gustilo-Anderson open fracture does not justify routine prophylactic Gram-negative antibiotic coverage

Takashi Suzuki  1 , Takahiro Inui  2 , Miyoshi Sakai  3 , Keisuke Ishii  2 , Taketo Kurozumi  4 , Yoshinobu Watanabe  2
Affiliations
Review

Type III Gustilo-Anderson open fracture does not justify routine prophylactic Gram-negative antibiotic coverage

Takashi Suzuki et al. Sci Rep. .

Abstract

Postoperative surgical site infection (SSI) is common in open long bone fractures, so early administration of prophylactic antibiotics is critical to prevent SSI. However, the necessity of initial broad-spectrum coverage for Gram-positive and -negative pathogens remains unclear. The purpose of this study was to clarify the effectiveness of prophylactic broad-spectrum antibiotics in a large, national-wide sample. We reviewed an open fracture database of prospectively collected data from 111 institutions managed by our society. A retrospective cohort study was designed to compare the rates of deep SSI between narrow- and broad-spectrum antibiotics, which were initiated within three hours after injury. A total of 1041 type III fractures were evaluated at three months after injury. Overall deep SSI rates did not differ significantly between the narrow-spectrum group (43/538, 8.0%) and broad-spectrum group (49/503, 9.8%) (p = 0.320). During propensity score-matched analysis, 425 pairs were analyzed. After matching, no significant difference in the SSI rate was seen between the narrow- and broad-spectrum groups, with 42 SSIs (9.9%) and 40 SSIs (9.4%), respectively (p = 0.816). The probability of deep SSI was not reduced by broad-spectrum antibiotics compared with narrow-spectrum antibiotics in type III open long bone fractures.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow diagram for inclusion and exclusion in the study. SSI: surgical site infection.
Figure 2
Figure 2
Distribution of commonly prescribed antibiotic combinations for open fractures in the narrow-spectrum group (a) and broad-spectrum group (b). CEZ: cefazolin; ABPC/SBT: ampicillin/sulbactam; CTM: cefotiam; AG: aminoglycoside; PIPC/TAZ: piperacillin/tazobactam; CTX: cefotaxime; CTRX: ceftriaxone.
Figure 3
Figure 3
Crude surgical site infection rates for major antibiotic regimens. CEZ: cefazolin; AG: aminoglycoside; PIPC/TAZ: piperacillin/tazobactam; CTX: cefotaxime; ABPC/SBT: ampicillin/sulbactam; CTRX: ceftriaxone.
Figure 4
Figure 4
Main culture results and prevalence of overall Gram-negative rod pathogens for surgical site infections in unmatched cohorts. MSSA: methicillin-susceptible Staphylococcus aureus; MRSA: methicillin-resistant Staphylococcus aureus.
See this image and copyright information in PMC

References

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