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Antibiotic Prophylaxis for Open Fractures in the Emergency Department

Antibiotic Prophylaxis for Open Fractures in the Emergency Department Emergency departments across the country regularly treat patients with traumatic injuries. One of the more common injuries that these patients present with is open fractures. Much of the morbidity associated with these fractures can be traced to the development of fracture-site infections that can lead to chronic osteomyelitis, impaired bone healing, and potential limb loss. Initial wound cultures in this setting are frequently positive, but they tend to demonstrate poor correlation with subsequent infections. The emergent management of open fractures includes a multipronged approach that includes stabilization, debridement, irrigation, soft tissue coverage, and systemic empiric antibiotics for prophylaxis. This review will discuss the etiology and factors associated with the development of infections in this setting, the use of empiric antibiotics, and the guidelines currently available. Key words: antibiotics, cefazolin, emergency department, gentamicin, open fracture NJURIES RESULTING FROM TRAUMA are and lead to an estimated 5.8 million deaths a common presentation to emergency de- per year (Lane, Mabvuure, Hindocha, & Khan, I partments (EDs) across the United States 2012). Open fractures, which are defined as “ . . . one in which the fracture fragments com- Author Affiliations: Pharmacy Services, Kentucky- municate with the environment through a One Health, University http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Advanced Emergency Nursing Journal Wolters Kluwer Health

Antibiotic Prophylaxis for Open Fractures in the Emergency Department

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Copyright
© 2015 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
1931-4485
eISSN
1931-4493
DOI
10.1097/TME.0000000000000052
Publisher site
See Article on Publisher Site

Abstract

Emergency departments across the country regularly treat patients with traumatic injuries. One of the more common injuries that these patients present with is open fractures. Much of the morbidity associated with these fractures can be traced to the development of fracture-site infections that can lead to chronic osteomyelitis, impaired bone healing, and potential limb loss. Initial wound cultures in this setting are frequently positive, but they tend to demonstrate poor correlation with subsequent infections. The emergent management of open fractures includes a multipronged approach that includes stabilization, debridement, irrigation, soft tissue coverage, and systemic empiric antibiotics for prophylaxis. This review will discuss the etiology and factors associated with the development of infections in this setting, the use of empiric antibiotics, and the guidelines currently available. Key words: antibiotics, cefazolin, emergency department, gentamicin, open fracture NJURIES RESULTING FROM TRAUMA are and lead to an estimated 5.8 million deaths a common presentation to emergency de- per year (Lane, Mabvuure, Hindocha, & Khan, I partments (EDs) across the United States 2012). Open fractures, which are defined as “ . . . one in which the fracture fragments com- Author Affiliations: Pharmacy Services, Kentucky- municate with the environment through a One Health, University

Journal

Advanced Emergency Nursing Journal – Wolters Kluwer Health

Published: Jan 1, 2015

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