【骨科指南】开放性骨折的抗生素预防性使用指南（英文版）.pdf

EASTPRACTICEMANAGEMENTGUIDELINES East Practice Management Guidelines Work Group: Update to Practice Management Guidelines for Prophylactic Antibiotic Use in Open Fractures William S. Hoff, MD, FACS, John A. Bonadies, MD, FACS, Riad Cachecho, MD, FACS, FCCP, and Warren C. Dorlac, MD, FACS STATEMENT OF THE PROBLEM An open fracture is defined as one in which the fracture fragments communicate with the environment through a break in the skin. The presence of an open fracture either isolated or as part of a multiple injury complex increases the risk of infection and soft tissue complications. In 1976, Gustilo and Anderson 1 described a system to classify open fractures based on the size of the associated laceration, the degree of soft issue injury, con- tamination, and presence of vascular compromise. In a subse- quent article, Gustilo et al. 2 refined the classification of severe open fractures. In general, risk of infection and incidence of limb loss correlate with the Gustilo type (Table 1). PROCESS By using a search methodology similar to Luchette et al., 3 a MEDLINE search was performed using the key words “open fractures” and “antibiotics.” This search was limited to articles published subsequent to the guidelines published by Luchette et al. This search yielded a total of 49 articles. Sixteen articles were excluded for the following reasons: technical article (6), non-English publication (5), insufficient contribution to the project (2), involved nonextremity frac- tures (2), and animal study (1). Thirteen secondary citations were obtained from bibliographies in the initial articles yield- ing 46 articles, which were reviewed by the subcommittee. Each article was reviewed and classified based on methodology described by the EAST Ad Hoc Committee on Guidelines Development and the Agency for Healthcare Pol- icy and Research of the US Department of Health and Human Services as follows 4,5 : Class I: prospective, randomized controlled study. Class II: prospective, randomiz