Does Local Aqueous Tobramycin Injection Reduce Open Fracture-Related Infection Rates?

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Pharmacology

Background:

• Fracture-related infections (FRIs) pose a significant challenge in orthopedic trauma surgery.
• Perioperative antibiotic prophylaxis is standard, but infection rates remain a concern for open fractures.

Purpose of the Study:

• To evaluate the efficacy of local aqueous tobramycin injection as an adjunct to standard intravenous (IV) antibiotic prophylaxis.
• To determine if this combined approach reduces the incidence of FRIs after open fracture fixation.

Main Methods:

• Retrospective cohort study at a single Level I trauma center.
• 157 patients with open extremity fractures undergoing reduction and internal fixation were analyzed.
• Intervention group received 80 mg local aqueous tobramycin during closure; control group did not.

Main Results:

• The FRI rate was significantly lower in the tobramycin group (11.5%) compared to the control group (25.3%) (P=0.026).
• This significant reduction in FRIs persisted after controlling for confounding variables like sex, fracture location, and Gustilo-Anderson classification (P=0.014).

Conclusions:

• Local aqueous tobramycin injection is an effective adjunct therapy for reducing FRIs in open extremity fractures.
• This method enhances the efficacy of standard perioperative IV antibiotic prophylaxis.