| Early antibiotics and debridement independently reduce infection in an open fracture model. | |
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MedLine Citation:
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PMID: 22219257 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Most animal studies indicate that early irrigation and debridement reduce infection after an open fracture. Unfortunately, these studies often do not involve antibiotics. Clinical studies indicate that the timing of initial debridement does not affect the rate of infection but these studies are observational and fraught with confounding variables. The purpose of this study was to control these variables using an animal model incorporating systemic antibiotics and surgical treatment. We used a rat femur model with a defect which was contaminated with Staphylococcus aureus and treated with a three-day course of systemic cefazolin (5 mg/kg 12-hourly) and debridement and irrigation, both of which were initiated independently at two, six and 24 hour time points. After 14 days the bone and hardware were harvested for separate microbiological analysis. No animal that received antibiotics and surgery two hours after injury had detectable bacteria. When antibiotics were started at two hours, a delay in surgical treatment from two to six hours significantly increased the development of infection (p = 0.047). However, delaying surgery to 24 hours increase the rate of infection, but not significantly (p = 0.054). The timing of antibiotics had a more significant effect on the proportion of positive samples than earlier surgery. Delaying antibiotics to six or 24 hours had a profoundly detrimental effect on the infection rate regardless of the timing of surgery. These findings are consistent with the concept that bacteria progress from a vulnerable planktonic form to a treatment-resistant biofilm. |
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Authors:
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J G Penn-Barwell; C K Murray; J C Wenke |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of bone and joint surgery. British volume Volume: 94 ISSN: 0301-620X ISO Abbreviation: J Bone Joint Surg Br Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-01-05 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375355 Medline TA: J Bone Joint Surg Br Country: England |
Other Details:
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Languages: eng Pagination: 107-12 Citation Subset: AIM; IM |
Affiliation:
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Royal Centre for Defence Medicine, Academic Department of Military Surgery and Trauma, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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