The Effect of Gel Containing Teicoplanin and Gentamicin the Prevention of Early Onset Bone Infection in Patients with Ga Type Ii and Iiiopen Fractures
Introduction: Wound infection is still one of the main complications leading to osteomyelitis. Systemic antibiotics reduce infection in the open fracture while local delivery of antibiotics can provide higher doses to wounds without toxic systemic effects. The aim of the present study was to compare the efficacy of systemic antibiotics alone and systemic antibiotics plus a local antibiotic gel in the treatment of patients with Gustilo-Anderson (GA) type II and III open fractures. Methods: 102 patients with GA type II and III open fractures and delayed fixation were included. The sterile gel and antibiotics (teicoplanin and gentamicin) were mixed under sterile conditions during surgery and then administrated at the fracture site. Microbial samples for culture and antibiogram were taken before and after fixation, and before first debridement. Patients were followed up for 3 weeks after surgery. Results: In general, 36% of patients who were debrided more than twice and 0% of those with more than 5 times debridement developed infection in the antibiotic gel group compared to 50% and 100% of those in the classic treatment group, respectively. The mean number of debridement times was different between the two groups, being less in the antibiotic gel group, but the difference was not significant (p=0.079). Twenty percent of GA grade IIIC cases developed wound infection compared to 40% of the classic group (p=1.00). Conclusion: Local antibiotic gel resulted in a lower rate of infection compared to classic treatment, yet the difference was not significant. The difference between the two groups for higher degree fractures (GA type IIIC) and more severe infection was more remarkable, meaning that patients with more severe fractures may benefit more from locally delivered antibiotics.
Amir Moayedpour, M Taghi Peivandi and Seid Reza Sharifi