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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Trauma Care

Background:

  • Open fractures pose significant morbidity risks due to potential infectious complications.
  • Prophylactic systemic antibiotics are currently recommended for open extremity fractures.
  • The Surgical Infection Society revised guidelines for antibiotic use in open fractures.

Purpose of the Study:

  • To update antibiotic use guidelines for open fractures based on current evidence.
  • To evaluate the efficacy of different antibiotic coverage strategies.
  • To provide evidence-based recommendations for managing open fracture infections.

Main Methods:

  • Systematic literature search of PubMed for relevant studies.
  • Evidence evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework.
  • Committee voting to accept or reject recommendations.

Main Results:

  • For type I or II open fractures, extended-spectrum antibiotic coverage is not recommended over gram-positive coverage alone.
  • For type III open fractures without active infection, antibiotic therapy should not exceed 24 hours.
  • Extended antimicrobial coverage beyond gram-positive organisms is not recommended for type III fractures.
  • Additional systemic antibiotic therapy is recommended for type III open fractures with bone loss.

Conclusions:

  • Antibiotic agents are crucial for preventing infection in open extremity fractures.
  • Current evidence supports limiting antibiotic duration and spectrum for specific open fracture types.
  • Further clinical trials are necessary to strengthen evidence and refine antibiotic protocols.