Pre-hospital antibiotics for open fractures : is there time?
CITATION: McCaul, J. K. & McCaul, M. G. 2014. Pre-hospital antibiotics for open fractures : is there time? South African Orthopaedic Journal, vol.13(1):34-38.
The original publication is available at http://www.scielo.org.za
Early administration of intravenous (IV) antibiotics providing cover against Gram positive and negative organisms can be argued to be the single most important factor in reducing infection rate in patients with open (compound) fractures. By examining trends in the time period from injury to ultimate administration of IV antibiotics, the authors aim to clarify if there would be opportunity for pre-hospital antibiotic administration to significantly shorten the delay. A retrospective and prospective descriptive study was conducted of all patients with open fractures of the limbs or girdles arriving via ambulance at a single district hospital in a suburban area in KwaZulu-Natal, South Africa. Thirty-eight patients were identified from May to December 2012. The median time from injury to antibiotics was 465 minutes (7.75 hours) (first quartile = 230 minutes, third quartile = 615). Administration of antibiotics was delayed beyond 3 hours in 78.9% (95% confidence interval [CI] 65.3-92.52) of patients and beyond 6 hours in 60.5% (95% CI 44.2-76.8). Although much of the delay occurred due to clinic and in-hospital delays, there is also a hypothetical window available to pre-hospital healthcare providers where antibiotics could be administered. This would potentially decrease the delay and bypass many of the difficulties encountered in-hospital.