Initial antibiotic treatment
Before starting therapeutic antibiotics, it is important to obtain adequate cultures, or PCR characterization (if available). At least 5 samples should be obtained in the operating room from different locations in the wound. Only if the patient has evidence of septicemia should antibiotics be given before wound exploration.
Selection of antibiotics for initial treatment is based on the antibiotic sensitivities of likely infecting organisms, including any results of previously positive cultures.
Generally, broad-spectrum, intravenous antibiotics are advisable as soon as cultures have been obtained. Initial antibiotics are selected, based on the results of gram’s stain, and on institutional frequency statistics (see table on left; Trampuz A, Zimmerli W (2006) Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 37 Suppl 2:S59-66.).