title: Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?
abstract: OBJECTIVE
  In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible.
  
  
  METHODS
  This was a retrospective case-control study on patients hospitalized from 2004 to 2009.
  
  
  RESULTS
  We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of ten days. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was three days and the median delay between trauma and surgery was one day. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome.
  
  
  CONCLUSIONS
  We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.
authors.affiliation: Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva, Switzerland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Domizio
authors.initials: D
authors.lastname: Suvà
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dunkel
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Nicodème
authors.forename: Antoine
authors.initials: A
authors.lastname: Lomessy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lauper
authors.forename: Peter
authors.initials: P
authors.lastname: Rohner
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D005260:Female; D005597:Fractures, Open / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D014946:Wound Infection / Q000517:prevention & control*