Balanced antibiotic stewardship needed for open fractures

Editor's Note

Antibiotic prophylaxis remains an important tool to lower risk of infection. In orthopedic open fracture repair there is high risk of postoperative infection, wound complications, and nonunion. However, providing effective antibiotic coverage to prevent infections must also be balanced with maintaining antibiotic stewardship to minimize resistance and adverse effects, according to a November 10 Science Speaks blog post from IDSA.

The authors noted it’s important to consider how under-treatment and over-treatment with antibiotics can both have significant consequences. They referenced following clinical guidance using the Gustilo-Anderson classification for Type 1, Type II or Type III injury severity. This classification can inform clinicians on appropriate practices for surgical management and antibiotic use. The authors also advocated selecting an antibiotic regimen that is tailored to the individual patient by accounting for their risk factors, prior colonization history, and overall clinical context.

Regarding specific antibiotics, they noted that “with the availability of advanced generation cephalosporins and carbapenems, we now have agents that provide more reliable coverage without the same challenges of dosing and toxicity that aminoglycosides carry.”