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Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Infection is a common complication of open fractures potentially leading to nonunion, functional loss, and even amputation. Perioperative antibiotic prophylaxis (PAP) is standard practice for infection prevention in the management of open fractures. However, optimal duration of PAP remains controversial. The objectives were to assess whether PAP duration is independently associated with infection in open fractures and if administration of PAP beyond the commonly-recommended limit of 72 h has any effect on the infection rate.

Materials and methods

Over a 14-year period from 2003 to 2017, 530 skeletally-mature patients with operatively-treated, non-pathologic, long-bone open fractures were treated at one institution. Twenty-eight patients were excluded because of death or loss to follow-up and the remaining 502 patients (with 559 open fractures) who completed a 24-month follow-up were included in this retrospective study. The outcome was fracture-related infection (FRI), defined by the criteria of a recent consensus definition. A logistic generalized estimating equations regression model was conducted, including PAP duration and variables selected by a least absolute shrinkage and selection operator (LASSO) method, to assess the association between PAP duration and FRI. Propensity score analysis using a 72-h cut-off was performed to further cope with confounding.

Results

PAP duration, adjusted for the LASSO selected predictors, was independently associated with FRI (OR: 1.11 [95%CI, 1.04–1.19] for every one-day increase in PAP duration, p = 0.003). PAP duration longer than 72 h did not significantly increase the odds for FRI compared to shorter durations (p = 0.06, analysis adjusted for propensity score).

Conclusions

This study found no evidence that administration of prophylactic antibiotics beyond 72 h in patients with long-bone open fractures is warranted. Analyses adjusted for known confounders even revealed a higher risk for FRI for longer PAP. However, this effect cannot necessarily be considered as causal and further research is needed.

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Authors and Affiliations

  1. Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Peter Declercq & Isabel Spriet

  2. Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Peter Declercq, Beatrijs Mertens, Julie Mesure & Isabel Spriet

  3. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA

    Charalampos Zalavras

  4. Department of Trauma Surgery, University Hospitals Leuven, 3000, Leuven, Belgium

    André Nijssen, Jorien Quintens, Thomas De Ridder, Stefaan Nijs & Willem-Jan Metsemakers

  5. KU Leuven, L-BioStat, 3000, Leuven, Belgium

    Ann Belmans

  6. Department of Development and Regeneration, KU Leuven, University of Leuven, 3000, Leuven, Belgium

    Stefaan Nijs & Willem-Jan Metsemakers

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  1. Peter Declercq
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Contributions

We confirm that all the authors contributed significantly to one or more aspects of the study: its design, data acquisition and analysis and interpretation of data. The manuscript has been read and approved by all named authors. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

Corresponding author

Correspondence to Peter Declercq.

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Conflict of interest

Prof. WJ. Metsemakers is a consultant for DePuy Synthes. He received speaker fees from DePuy Synthes, BoneSupport and ZiomerBiomet. Prof. S. Nijs is a consultant for DePuy Synthes, Materialise and ZimmerBiomet. All the above are outside the submitted work. All the other authors declare that they have no conflict of interest.

Ethical approval

This is a retrospective case–control study involving human data. It is conducted at the University Hospitals Leuven, which is a designated level I trauma referral center in Belgium. The study time period was January 2003 to January 2017 and the protocol was approved by the hospital’s Ethics Committee (S58022, OG032).

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Declercq, P., Zalavras, C., Nijssen, A. et al. Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures. Arch Orthop Trauma Surg 141, 235–243 (2021). https://doi.org/10.1007/s00402-020-03474-8

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  • DOI: https://doi.org/10.1007/s00402-020-03474-8

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