Gram-Negative Antibiotic Coverage in Gustilo-Anderson Type-III Open Fractures

➢ Gustilo-Anderson type-III open fractures remain a considerable cause of morbidity and amputation. ➢ Systemic antibiotic prophylaxis with cephalosporins was introduced in the 1970s and substantially reduced the prevalence of infectious complications following injury. ➢ The use of antibiotics with an extended gram-negative (EGN) spectrum, such as aminoglycosides, is controversial; however, they are commonly used in type-III open fractures. ➢ Emerging literature has suggested that EGN antibiotic prophylaxis for type-III open fractures may not reduce infectious complication rates. ➢ Reducing the routine use of EGN antibiotics may be an important component of antimicrobial stewardship in orthopaedic trauma to reduce bacterial resistance and thus more complicated infections.