Background: Prolonged courses of broad-spectrum antibiotics are often cited as the standard
of care for prevention of infective complications of open fractures. The origins of these recommendations
are obscure, however, and multi-drug-resistant systemic infections attributable
to antibiotic overuse are common life-threatening problems in current intensive care unit
practice.
Objective: To review systematically the effects of prophylactic antibiotic administration on
the incidence of infections complicating open fractures.
Data Sources: Computerized bibliographic search of published research and citation review
of relevant articles.
Study Selection: All published clinical trials claiming to evaluate, or cited elsewhere as being
authoritative regarding, the role of antibiotics in open fracture management were identified
and then evaluated according to published guidelines for evidence-based medicine. Only
small studies (<20 patients), practice surveys, pharmacokinetic studies, and reviews or duplicative
publications presenting primary data already considered were excluded from analysis.
Data Extraction: Information on demographics, study dates, fracture grade, antibiotic type,
duration and route of administration, surgical interventions, infection-related outcomes, and
the methodologic quality of the studies was extracted by the authors. The primary results
were submitted to the Therapeutic Agents Committee of the Surgical Infection Society for review
prior to creation of the final consensus document.
Data Synthesis: Current antibiotic management of open fractures is based on a small number
of studies that generally are more than 30 years old and do not reflect current management
priorities in trauma and critical care. With a few noteworthy exceptions, these primary
studies suffer from a variety of methodologic problems, including commingling of prospective
and retrospective data sets, absence of or inappropriate statistical analysis, lack of blinding,
or failure of randomization.
