Abstract | BACKGROUND: METHODS: Three hundred and fifty-one open fractures were identified by Current Procedural Terminology codes 11011 and 11012. Data on patient demographic characteristics, injury characteristics, infection, and fracture union were obtained from the electronic medical records. Patients in the control group (183 fractures) received systemic antibiotics only. Patients in the intervention group (168 fractures) received, in addition to systemic antibiotics, a locally administered aminoglycoside (2 mg/mL) at the time of the index surgical procedure. At the discretion of the attending surgeon, some wounds also received postoperative irrigations of aqueous aminoglycoside (n = 34). For wounds that could not be closed and wounds that received postoperative irrigations, negative pressure dressings were used. RESULTS: The deep and superficial infection rate in the control group was 19.7% (thirty-six of 183 fractures), but it was significantly lower (p = 0.010) in the intervention group at 9.5% (sixteen of 168 fractures). When comparing only the deep infections, the infection rate in the control group was 14.2% (twenty-six of 183 fractures) compared with 6.0% (ten of 168 fractures) in the intervention group (p = 0.011). After multivariate analysis to adjust for possible confounding factors, the administration of local antibiotics was found to be an independent predictor of lower infection rates in both deep and superficial infections (odds ratio, 2.6 [95% confidence interval, 1.2 to 5.6]; p = 0.015) and deep infections only (odds ratio, 3.0 [95% confidence interval, 1.1 to 8.5]; p = 0.034). The use of local antibiotics did not have an impact on nonunion rate (p = 0.881), with a type-I error rate of α = 0.05 and 0.8 power. CONCLUSIONS:
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Authors | Cheryl Reese Lawing, Feng-Chang Lin, Laurence E Dahners |
Journal | The Journal of bone and joint surgery. American volume
(J Bone Joint Surg Am)
Vol. 97
Issue 22
Pg. 1844-51
(Nov 18 2015)
ISSN: 1535-1386 [Electronic] United States |
PMID | 26582614
(Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated. |
Chemical References |
- Anti-Bacterial Agents
- Gentamicins
- Tobramycin
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Topics |
- Adult
- Anti-Bacterial Agents
(administration & dosage, therapeutic use)
- Antibiotic Prophylaxis
(methods)
- Female
- Follow-Up Studies
- Fracture Fixation
- Fractures, Open
(surgery)
- Gentamicins
(administration & dosage, therapeutic use)
- Humans
- Injections, Intralesional
- Male
- Middle Aged
- Prevalence
- Retrospective Studies
- Single-Blind Method
- Surgical Wound Infection
(epidemiology, prevention & control)
- Tobramycin
(administration & dosage, therapeutic use)
- Treatment Outcome
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