Does prophylactic local tobramycin injection lower open fracture infection rates?

Abstract

<b>Objective:</b> To determine whether local aqueous tobramycin injection in combination with systemic perioperative IV antibiotic prophylaxis will reduce the rate of fracture-related infection (FRI) after open fracture fixation. <b>Other Outcomes of Interest:</b> (1) To compare fracture nonunion rates and report differences between treatment and control groups and (2) compare bacterial speciation and antibiotic sensitivity among groups that develop FRI. <b>Design:</b> Phase 3 prospective, randomized clinical trial. <b>Setting:</b> Two level 1 trauma centers. <b>Participants:</b> Six hundred subjects (300 in study/tobramycin group and 300 in control/standard practice group) will be enrolled and assigned to the study group or control group using a randomization table. Patients with open extremity fractures that receive definitive internal surgical fixation will be considered. <b>Intervention:</b> Aqueous local tobramycin will be injected into the wound cavity (down to bone) after debridement, irrigation, and fixation, following closure. <b>Main Outcome Measurements:</b> Outcomes will look at the presence or absence of FRI, the rate of fracture nonunion, and determine speciation of gram-negative and Staph bacteria in each group with a FRI. <b>Results:</b> Not applicable. <b>Conclusion:</b> The proposed work will determine whether local tobramycin delivery plus perioperative standard antibiotic synergism will minimize the occurrence of open extremity FRI. <b>Level of Evidence:</b> Level 1.