The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: a 6-year prospective study after a change in policy

JOURNAL TITLE: Strategies in Trauma and Limb Reconstruction

Author
1. Hristifor Gality
2. Zoltan Kiraly
3. Sean Vanstone
4. Shane Apperley
5. David A. Woods
6. Andreas Leonidou
ISSN
1828-8936
DOI
10.1007/s11751-014-0208-9
Volume
9
Issue
3
Publishing Year
2014
Pages
5
Author Affiliations
    1. First Department of Trauma and Orthopaedics, Athens Paediatric Hospital “Agia Sophia”, Thivon and Papadiamantopoulou, Goudi, 11527 Athens, Greece; Division of Surgery, Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Thessaloníki, Greece
    1. Department of Trauma and Orthopaedic Surgery, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK
    1. Department of Trauma and Orthopaedic Surgery, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK
    1. Department of Trauma and Orthopaedic Surgery, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK
    1. Department of Trauma and Orthopaedic Surgery, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK
    1. Department of Trauma and Orthopaedic Surgery, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon SN3 6BB, UK
  • Article keywords
    Open long-bone fracture, Time to theatre, Grade of surgeon, Infection rate

    Abstract

    Our current protocol in treating open long-bone fractures includes early administration of intravenous antibiotics and surgery on a scheduled trauma list. This represents a change from a previous protocol where treatment as soon as possible after injury was carried out. This review reports the infection rates in the period 6 years after the start of this protocol. Two hundred and twenty open long-bone fractures were reviewed. Data collected included time of administration of antibiotics, time to theatre and seniority of surgeon involved. The patients were followed up until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed. Clinical, radiological and haematological signs of infection were documented. If present, infection was classified as deep or superficial. Surgical debridement was performed within 6 h of injury in 45 % of cases and after 6 h in 55 % of cases. Overall infection rates were 11 and 15.7 %, respectively (p = 0.49). The overall deep infection rate was 4.3 %. There was also no statistically significant difference in the subgroups of deep (p = 0.46) and superficial (p = 0.78) infection. Intravenous antibiotics were administered within 3 h of injury in 80 % of cases and after 3 h in 20 % of cases. The infection rates were 14 and 12.5 %, respectively (p = 1.0). There was no statistically significant difference in the subgroups of deep (p = 0.62) and superficial (p = 0.73) infection. Further statistical analysis did not reveal a significant difference in infection rates for any combination of timing of antibiotics and surgical debridement. Infection rates where the most senior surgeon present was a consultant were 9.5 % as opposed to 16 % with the consultant not present, but this trend was not statistically significant. These results suggest that the change in policy may have contributed to an improvement of the deep infection rate to 4.3 % from the previous figure of 8.5 % although this decrease is not statistically significant. Surgeons may have had concerns that delaying theatre may lead to an increased infection rate, but these results do not substantiate this concern.

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