Antibiotic prophylaxis for preventing open fracture related infections - A scoping review

The primary aim was to report available literature on antibiotic prophylaxis against open fracture-related infections, in populations with antimicrobial resistance patterns similar to Denmark's as reported by the European Antimicrobial Resistance Surveillance Network. Countries included: Denmark, Finland, Germany, Great Britain, Iceland, the Netherlands, Norway, and Sweden. A secondary aim was to compare Danish regional guidelines with these findings.

PubMed, Medline, and Embase were searched for studies published between January 1998 and March 2024. Danish guidelines were retrieved on May 7^th, 2024, through a systematic search.

Out of 6492 studies, 120 were screened in full, and 19 were included for analysis. 9 studies recommended cephalosporins (primarily 1st and 2nd generations) for Gustilo-Anderson Grades I and II, while 10 studies supported further gram-negative coverage for Gustilo-Anderson grade IIIa-c fractures. One study found no significant benefit of antibiotic prophylaxis for reducing fracture-related infections. Danish guidelines varied: The Capital Region of Denmark recommends gram-negative coverage for all Gustilo-Anderson grades, whereas the Region of Southern Denmark and 10/19 studies only recommend it for Gustilo-Anderson grade IIIa-c fractures.

This review identifies a lack of data on pathogens causing FRI in regions with similar antimicrobial resistance patterns according to the EARS-Net, complicating optimal antibiotic strategies. The variability of open fractures underscores the need for research to utilize the Gustilo-Anderson classification when planning the treatment regime, focusing on specific grades to improve targeted AP for preventing FRI. Furthermore, taking the cultures after sufficient surgical debridement. Future high-quality studies in populations with homogeneous antimicrobial resistance patterns are needed to optimize national AP protocols.