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Purpose: Patients with open fractures receive antibiotics to reduce the risk of future infections based on the Eastern Association for the Surgery of Trauma (EAST) Guidelines. Although recommendations exist, there are currently limited data supporting the use and appropriate selection of antibiotics for osteomyelitis prophylaxis in open fractures. The purpose of this study is to evaluate guideline practices’ impact on osteomyelitis rates.
Methods: This observational, retrospective, single-center study included adults with lower extremity open fractures of the ankle, tibia, fibula, or femur from January 2009 to March 2011. Demographic data, Gustilo fracture grade, antibiotics used, timing of antibiotics, and development of osteomyelitis within a year of wound closure were recorded. The primary endpoint was the incidence of osteomyelitis following open fracture. Secondary endpoint comparisons include infection rates between fracture grades, relationship between time of antibiotic initiation and infection rates, and impact of prolonged prophylaxis after closure.
Results: A total of 96 patients were included. Patients suffered from Gustilo grade fractures 1 (12.5%), 2 (54.2%), 3a (26%), 3b (2%), and 3c (1%). Almost all patients received cefazolin (96%). Of the 25 grade 3 fractures, 16 patients received Gram-negative coverage with gentamicin (13), aztreonam (3), piperacillin-tazobactam (1), or ceftriaxone (1). The average time from patient presentation to antibiotic administration was 6.2 hours. The rate of osteomyelitis was 9.3%, with all cases involving Gustilo grades 2 (6.2%) and 3 (3.1%) fractures. All of the grade 3 fracture patients with osteomyelitis received Gram-negative coverage along with cefazolin.
Conclusions: The rate of osteomyelitis was slightly higher than in other previously published studies with osteomyelitis rates of 7% and 6.5%. These increased rates require further evaluation to help optimize open fracture antibiotic prophylaxis.