The Use of Prophylactic Antibiotics as a Prevention of Surgical Site Infection for Patients with Open Fracture: A Scoping Review

Background: Fracture is a serious injury condition characterized by structural discontinuity of the bone that occurs in the form of cracks to complete, and bone fragments are not in their proper position. The incidence of open fractures is 30.7 out of 100,000 people per year. Based on the relationship with the outside world, fractures are divided into two, if the skin is still intact after breaking, it is called a closed fracture, and if there is a wound, it is called an open fracture. An open fracture is an emergency condition that can be life-threatening if not treated adequately. This is due to the relationship of fracture fragments with the outside world, which allows contamination to occur. Complications resulting from contamination are the occurrence of infection. The event of infection can cause a worsening of the patient's clinical condition. Thus, the socio-economic burden of the sufferer will increase. Therefore, prompt and appropriate treatment is needed, one of which is prophylactic antibiotics.

Objectives: This scoping review aims to analyze the effectiveness of prophylactic antibiotics in cases of open fractures for the prevention of surgical site infection.

Methods: Article searches were conducted using two online databases, PubMed and Scopus. The articles searched were published between 2017-2021, with the main keywords used being prophylactic antibiotics, surgical site infections, and open fracture.

Results: Four articles were selected from the article search process. Based on the article review results, it is known that Staphylococcus aureus is the most common microorganism causing surgical site infection. The use of prophylactic antibiotics should be given as soon as possible after an open fracture. The most used prophylactic antibiotics are cephalosporins. The duration of use of prophylactic antibiotics is still not according to existing recommendations.

Conclusion: The incidence of surgical site infection can affect healing time, length of hospitalization, repeated procedures, and increased costs. In open fractures of GA type I and II, it is recommended to use prophylactic antibiotics of first or second-generation cephalosporin. For open fractures of GA type III, it is recommended that third-generation cephalosporin be used with an aminoglycoside as prophylactic antibiotics. The duration of prophylactic antibiotics is 24-72 hours. Further research is needed to determine the most effective prophylactic antibiotics and the optimal period to prevent surgical site infections and bacterial resistance.