ArticleThe journal of trauma and acute care surgery2017
Early infectious outcomes after addition of fluoroquinolone or aminoglycoside to posttrauma antibiotic prophylaxis in combat-related open fracture injuries.
Article in The journal of trauma and acute care surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement.Prehospital emergency care · 2024Guideline
- Optimizing antibiotic prophylaxis for type III open fractures in China: a cost-effectiveness analysis.Health and quality of life outcomes · 2026Article
- Twenty common errors in the prevention, diagnosis, and treatment of fracture-related infection (FRI).Journal of bone and joint infection · 2026Review
- Article
- Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients.PloS one · 2023Article
- Department of Defense Trauma Registry Infectious Disease Module Impact on Clinical Practice.Military medicine · 2022Review
- IDCRP Combat-Related Extremity Wound Infection Research.Military medicine · 2022Review
- IDCRP Trauma-Related Infection Research.Military medicine · 2022Article
- Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital.International orthopaedics · 2020Article
- Retrospective analysis of risk factors for deep infection in lower limb Gustilo-Anderson type III fractures.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2020Observational
- Evaluation of infection rates with narrow versus broad-spectrum antibiotic regimens in civilian gunshot open-fracture injury.The American journal of emergency medicine · 2020Article
- Antibiotic Practice Patterns for Extremity Wound Infections among Blast-Injured Subjects.Military medicine · 2020Article
- After the Battlefield: Infectious Complications among Wounded Warriors in the Trauma Infectious Disease Outcomes Study.Military medicine · 2019Article
- Antimicrobial Prophylaxis with Combat-Related Open Soft-Tissue Injuries.Military medicine · 2018Article
- Infection prevention for open fractures: Is antibiotic monotherapy equivalent to multitherapy?International journal of critical illness and injury scienceArticle
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundWe examined combat-related open extremity fracture infections as a function of whether posttrauma antimicrobial prophylaxis included expanded Gram-negative (EGN) coverage.
methodsMilitary personnel with open extremity fractures sustained in Iraq and Afghanistan (2009-2014) who transferred to participating hospitals in the United States were assessed. The analysis was restricted to patients with a U.S. hospitalization period of ≥7 days. Prophylaxis was classified as narrow (e.g., IV cefazolin, clindamycin, and/or amoxicillin-clavulanate) or EGN, if the prophylactic regimen included fluoroquinolones and/or aminoglycosides.
resultsThe study population included 1,044 patients, of which 585 (56%) and 459 (44%) received narrow and EGN coverage, respectively (p < 0.001). Skin and soft-tissue infections (SSTIs) were more common among patients who received narrow prophylaxis compared to EGN coverage (28% vs. 22%; p = 0.029), whereas osteomyelitis rates were comparable between regimens (8%). Similar findings were noted when endpoints were measured at 2 and 4 weeks postinjury. There was no significant difference related to length of hospitalization between narrow and EGN regimens (median: 34 and 32 days, respectively) or operating room visits (median: 5 and 4). A higher proportion of EGN coverage patients had Gram-negative organisms isolated that were not susceptible to fluoroquinolones and/or aminoglycosides (49% vs. 40%; p < 0.001). In a Cox proportional model, narrow prophylaxis was independently associated with an increased risk of extremity SSTIs (hazard ratio: 1.41; 95% confidence interval: 1.09-1.83). DISCUSSION: Despite seeing a small benefit with EGN coverage related to a reduction of SSTIs, it does not decrease the risk of osteomyelitis, and there seems to be a cost of increased antibiotic resistance associated with use. Overall, our findings support the current post-combat trauma antibiotic prophylaxis guidelines, which recommend the use of cefazolin or clindamycin with open fractures. LEVEL OF EVIDENCE: Prognostic/Epidemiological, Level II; Therapy, level IV.
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