Effect of emergency department antibiotic delivery time and protocol compliance on infection after open fractures: a systematic review and meta-analysis

Authors

  • Mazi Mohammed Alanazi Saudi and Jordanian Board Emergency Medicine, Emergency Department, Head of Emergency Research Unit, First Health Cluster, Riyadh, Saudi Arabia. ORCID: 0009-0003-5836-8086. Author
  • Khalid Nedhal Ayoub Medical Student, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Author
  • Duna Fayyadh Aljbab Medical intern, College of Medicine, Jouf University, Al Jouf, Saudi Arabia. Author
  • Zahra Abdullah Alzain General Physician, College of Medicine, King Khalid University, Abha, Saudi Arabia. Author
  • Omnia Hani Almomen General practitioner, College of medicine, Imam Abdulrahaman Bin Faisal University, Dammam, Saudi Arabia. Author
  • Manar Menwer Altalhi Medical intern, College of Medicine, Taif University, Taif, Saudi Arabia. Author
  • Khalid Attiyah Albishri Medical intern, College of Medicine, Jeddah University, Jeddah, Saudi Arabia. Author
  • Omar Fahad Alshalawi Medical intern, College of Medicine, Um Alqura University, Makkah, Saudi Arabia. Author
  • Faisal Talal Said Althobaiti Medical intern, College of Medicine, Taif University, Taif, Saudi Arabia. Author
  • Waleed Abdullah AlRashoud Medical intern, College of medicine, King Saud University, Riyadh, Saudi Arabia. Author

DOI:

https://doi.org/10.65759/1meszk13

Keywords:

Open fractures, antibiotic prophylaxis, emergency department, antibiotic timing, compliance

Abstract

Background: Antibiotic prophylaxis is established in open fracture management, the infection benefit associated with specific emergency department delivery thresholds. This review evaluated delivery time, compliance, and infection outcomes. Methods: Original comparative studies published through May 2026 were examined. All comparisons were observational. Comparisons involved heterogeneous populations. Injury to antibiotic and arrival to antibiotic intervals were distinguished. Timing findings were synthesized narratively. An exploratory random-effects meta-analysis combined two studies reporting infection in patients receiving guideline-compliant versus noncompliant prophylaxis. Results: Ten primary studies addressed timing, compliance, or protocol implementation. Delays exceeding 66 minutes after injury and 120 minutes after emergency department presentation were associated with infection in individual cohorts. Other studies, including a May 2026 cohort, found no significant association at the one-hour arrival threshold. In two compliance cohorts comprising 416 patients, infection occurred in 19 of 128 compliant patients and 51 of 288 noncompliant patients. The pooled risk ratio was 0.84 (95% confidence interval 0.52–1.37; I²=0%). This outcome represented surgical and nonsurgical infections rather than exclusively deep fracture infection. Protocol implementation studies show reduced broad-spectrum antibiotic use without significant infection reductions. Conclusion: Observational data supports avoiding preventable antibiotic delays without establishing a universal infection threshold. The exploratory compliance estimate still inconclusive. Standardized exposure clocks, fracture-specific outcomes, and adjustment for injury severity are essential for interpreting emergency department antibiotic performance.

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Published

2026-10-08

Issue

Vol. 3 No. 04 (2026): Journal of Tazeez for Public Health

Section

Articles