title: Prophylactic antibiotics in open fractures: a pilot randomized clinical safety study.
abstract: OBJECTIVE
  To develop preliminary data on Staphylococcus aureus colonization and surgical site infections (SSIs) in patients with open fractures who received standard antibiotic prophylaxis compared with a regimen including targeted methicillin-resistant Staphylococcus aureus (MRSA) coverage.
  
  
  METHODS
  Randomized prospective clinical trial.
  
  
  METHODS
  Adult patients who presented to the emergency department with an open fracture between April 2009 and July 2011.
  
  
  METHODS
  One hundred thirty patients were randomized to receive prophylaxis with either cefazolin alone (control arm) or vancomycin and cefazolin (experimental arm) from presentation to the emergency department until 24 hours after the surgical intervention. Screening for S. aureus carriage was performed with nares swabs and predebridement and postdebridement open fracture wound swabs. Patients underwent prospective assessment for the development of SSI for no less than 30 days and up to 12 months.
  
  
  RESULTS
  Nasal colonization of methicillin-sensitive S. aureus and MRSA among the sample was 20% and 3%, respectively. No significant difference in the rates of SSI was observed between the study arms (15% vs 19%, respectively, P = 0.62). Staphylococcus aureus caused 55% of the deep incisional/organ space SSI, with 18% attributed to MRSA. A significantly higher rate of MRSA SSIs was observed among MRSA carriers compared with noncarriers (33% vs 1%, respectively, P = 0.003).
  
  
  CONCLUSIONS
  Staphylococcus aureus nasal colonization in trauma patients with open fractures is similar to that of the general community. In this pilot study, the addition of vancomycin to standard antibiotic prophylaxis was found safe, but its efficacy should be evaluated in a larger multiinstitutional trial.
authors: *Department of Medicine, Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado; †Department of Orthopaedic Surgery, Swedish Medical Center, Denver, Colorado; Departments of ‡Medicine, Infectious Diseases, and §Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado; ‖Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado; ¶Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado; and **Denver Health Medical Center, Denver, Colorado.
authors: Carla C
authors: CC
authors: Saveli
authors: Steven J
authors: SJ
authors: Morgan
authors: Robert W
authors: RW
authors: Belknap
authors: Erin
authors: E
authors: Ross
authors: Philip F
authors: PF
authors: Stahel
authors: George W
authors: GW
authors: Chaus
authors: David J
authors: DJ
authors: Hak
authors: Walter L
authors: WL
authors: Biffl
authors: Bryan
authors: B
authors: Knepper
authors: Connie S
authors: CS
authors: Price
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data; D005597:Fractures, Open / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D010865:Pilot Projects; D011292:Premedication / Q000706:statistics & numerical data; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin