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Benzylpenicillin ineffective for open fractures. Prospective study of 60 cases

S Vainionpää1, J Vasenius, P Rokkanen

  • 1Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Finland.

Acta Orthopaedica Scandinavica
|April 1, 1990
PubMed

Insights

Prophylactic antibiotics showed limited effectiveness in preventing open fracture infections, particularly against common bacteria like Staphylococcus. Penicillin and cephalosporins demonstrated significant resistance, highlighting the need for alternative treatments for fracture-related infections.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Pharmacology

Background:

  • Open fractures carry a high risk of infection, complicating treatment and outcomes.
  • Prophylactic antibiotics are standard care, but their efficacy against common pathogens needs evaluation.

Purpose of the Study:

  • To assess the effectiveness of prophylactic antibiotics in preventing infections in open fractures.
  • To determine the resistance patterns of common bacterial pathogens to penicillin and cephalosporins.

Main Methods:

  • A prospective study involving 60 patients with open fractures treated with prophylactic antibiotics.
  • Infection rates were analyzed based on fracture grade (Gustilo-Anderson classification).
  • Bacterial cultures were performed, and antibiotic susceptibility testing was conducted for penicillin and second-generation cephalosporins.

Main Results:

  • 10 out of 60 open fractures developed infection (16.7%).
  • Infection rates were higher in Grade 3 fractures (8/20) compared to Grades 1 and 2 (2/40).
  • High resistance rates were observed: 62% of initial cultures and 92% of infection cultures were penicillin-resistant. Cephalosporin resistance was 21% and 30% respectively.

Conclusions:

  • Prophylactic antibiotics, including penicillin and second-generation cephalosporins, show limited efficacy in preventing open fracture infections due to high bacterial resistance.
  • Staphylococcus aureus and epidermidis are common pathogens, often resistant to commonly used antibiotics.
  • Further research is needed to identify more effective antibiotic strategies for open fracture prophylaxis.

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