Evaluation of Institutional Prophylactic Open Fracture Antibiotic Guidelines on Infection Development

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Pharmacy Stewardship

Background:

• Open fracture wounds carry a high risk of infection, influenced by fracture location, antibiotic choice, and timing.
• Current guidelines lack consensus on optimal antibiotic selection and duration for open fractures.
• Optimizing prophylactic antibiotic use presents a significant stewardship opportunity for pharmacy departments.

Purpose of the Study:

• To evaluate the impact of updated institutional antibiotic guidelines on open fracture infection rates.
• To assess adherence to antibiotic ordering protocols post-guideline implementation.
• To analyze the 60-day incidence of open fracture-related infections.

Main Methods:

• Retrospective chart review of 150 patients with open fractures (July 2014 - November 2018).
• Patients divided into pre-implementation (n=75) and post-implementation (n=75) groups based on March 2016 guideline change.
• Data collected included demographics, fracture site, Gustilo-Anderson grade, infection rates, and antibiotic usage.

Main Results:

• No significant reduction in 60-day infection rates observed post-guideline implementation (6.7% pre vs. 5.3% post).
• 12-month infection rates showed a similar trend (9.3% pre vs. 6.7% post).
• Less than 50% of patients had documented Gustilo-Anderson fracture grading.

Conclusions:

• Institutional guideline updates did not significantly decrease open fracture infection rates.
• Low adherence to guidelines and inadequate fracture grading documentation likely contributed to the lack of improvement.
• Future strategies should prioritize enhancing compliance and developing consensus guidelines for effective infection prevention.