Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study
Abstract Background Open fractures, particularly Gustilo-Anderson grade III injuries, carry high risks of infection. This cohort study compared the effectiveness of three prophylactic antibiotic regimens in reducing a range of infection-related outcomes, including infection markers (ESR, CRP), wound...
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BMC
2025-08-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-025-09063-3 |
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| author | Mohammad Sheibani Amirreza Sadeghifar Shahriyar Shafa Salman Azarsina Mohammad Sajjad Mirhoseini Mahdi Mohammaditabar Elham al-Sadat Seyyed Ghasemi Nima Rafati |
| author_facet | Mohammad Sheibani Amirreza Sadeghifar Shahriyar Shafa Salman Azarsina Mohammad Sajjad Mirhoseini Mahdi Mohammaditabar Elham al-Sadat Seyyed Ghasemi Nima Rafati |
| author_sort | Mohammad Sheibani |
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| description | Abstract Background Open fractures, particularly Gustilo-Anderson grade III injuries, carry high risks of infection. This cohort study compared the effectiveness of three prophylactic antibiotic regimens in reducing a range of infection-related outcomes, including infection markers (ESR, CRP), wound colonization, clinical infections, fever, cellulitis, and abscess formation. Methods In this prospective cohort study, 600 patients aged 18–85 years with open fractures were enrolled at Shahid Bahonar Hospital, Iran (2020–2022). Participants were grouped by clinician-selected regimens: Group A (Cefazolin 1 g every 6 h + amikacin), Group B (Cefazolin 2 g every 8 h + amikacin), and Group C (Vancomycin 2 g every 12 h + amikacin). Multivariable logistic regression adjusted for confounders (age, fracture severity). Missing data (< 5%) were imputed. Results Of 978 patients screened, 600 completed follow-ups. Baseline demographics (mean age: 31.2 years; 82% male) were balanced. Group C had lower rates of elevated ESR (4.8% vs. 8.0% in Group A; adjusted RR = 0.61, 95% CI: 0.40–0.92), clinical infection (4.7% vs. 8.0%; RR = 0.58, CI: 0.38–0.89), and deep infection (2.7% vs. 5.3%; RR = 0.51, CI: 0.29–0.90). Minor adverse events (rash/nausea) were balanced across all groups (5.5% overall), with no significant differences in incidence or type between regimens. Conclusion Vancomycin-amikacin was associated with reduced infection markers and complications compared to cefazolin regimens in this observational cohort, supporting its consideration in high-risk settings. Causality requires confirmation through randomized trials. |
| format | Article |
| id | doaj-art-7e191df335af434c8b5dc287a46677ce |
| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-7e191df335af434c8b5dc287a46677ce2025-08-24T11:03:36ZengBMCBMC Musculoskeletal Disorders1471-24742025-08-012611510.1186/s12891-025-09063-3Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort studyMohammad Sheibani0Amirreza Sadeghifar1Shahriyar Shafa2Salman Azarsina3Mohammad Sajjad Mirhoseini4Mahdi Mohammaditabar5Elham al-Sadat Seyyed Ghasemi6Nima Rafati7Clinical Research Development Unit, School of Medicine, Shahid Madani Hospital, Alborz University of Medical SciencesOrthopedic Department, Afzalipour School of Medicine, Kerman University of Medical SciencesOphtalmology department, Kerman University of Medical SciencesClinical Research Development Unit, School of Medicine, Shahid Madani Hospital, Alborz University of Medical SciencesClinical Research Development Unit, School of Medicine, Shahid Madani Hospital, Alborz University of Medical SciencesStudent Research Committee, School of Medicine, Alborz University of Medical SciencesStudent Research Committee, School of Medicine, Iran University of Medical SciencesDepartment of Orthopedics, School of Medicine, Clinical Research Development Unit, Shahid Madani Hospital, Alborz University of Medical SciencesAbstract Background Open fractures, particularly Gustilo-Anderson grade III injuries, carry high risks of infection. This cohort study compared the effectiveness of three prophylactic antibiotic regimens in reducing a range of infection-related outcomes, including infection markers (ESR, CRP), wound colonization, clinical infections, fever, cellulitis, and abscess formation. Methods In this prospective cohort study, 600 patients aged 18–85 years with open fractures were enrolled at Shahid Bahonar Hospital, Iran (2020–2022). Participants were grouped by clinician-selected regimens: Group A (Cefazolin 1 g every 6 h + amikacin), Group B (Cefazolin 2 g every 8 h + amikacin), and Group C (Vancomycin 2 g every 12 h + amikacin). Multivariable logistic regression adjusted for confounders (age, fracture severity). Missing data (< 5%) were imputed. Results Of 978 patients screened, 600 completed follow-ups. Baseline demographics (mean age: 31.2 years; 82% male) were balanced. Group C had lower rates of elevated ESR (4.8% vs. 8.0% in Group A; adjusted RR = 0.61, 95% CI: 0.40–0.92), clinical infection (4.7% vs. 8.0%; RR = 0.58, CI: 0.38–0.89), and deep infection (2.7% vs. 5.3%; RR = 0.51, CI: 0.29–0.90). Minor adverse events (rash/nausea) were balanced across all groups (5.5% overall), with no significant differences in incidence or type between regimens. Conclusion Vancomycin-amikacin was associated with reduced infection markers and complications compared to cefazolin regimens in this observational cohort, supporting its consideration in high-risk settings. Causality requires confirmation through randomized trials.https://doi.org/10.1186/s12891-025-09063-3Open fracturesProphylactic antibioticsVancomycinCefazolinInfection preventionCohort study |
| spellingShingle | Mohammad Sheibani Amirreza Sadeghifar Shahriyar Shafa Salman Azarsina Mohammad Sajjad Mirhoseini Mahdi Mohammaditabar Elham al-Sadat Seyyed Ghasemi Nima Rafati Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study BMC Musculoskeletal Disorders Open fractures Prophylactic antibiotics Vancomycin Cefazolin Infection prevention Cohort study |
| title | Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study |
| title_full | Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study |
| title_fullStr | Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study |
| title_full_unstemmed | Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study |
| title_short | Comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures: a prospective cohort study |
| title_sort | comparative effectiveness of prophylactic antibiotic regimens in preventing infection in open fractures a prospective cohort study |
| topic | Open fractures Prophylactic antibiotics Vancomycin Cefazolin Infection prevention Cohort study |
| url | https://doi.org/10.1186/s12891-025-09063-3 |
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