Reported practice patterns in the use of local antibiotics for fracture-related infection among SICOT respondents: an international survey.

Abstract

Background: Local antibiotics are increasingly used in the management of fracture-related infection (FRI), but international practice patterns regarding their indications, antibiotic selection, and application methods remain heterogeneous and insufficiently standardised.

Methods: An international survey was conducted among members of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT). The web-based questionnaire included 16 items on indications, antibiotic selection, and application methods. Participation was voluntary and self-selected. Responses were analysed descriptively, with regional stratification performed for exploratory purposes. Of 118 started questionnaires, 87 were included in the analysis (73.7%); the overall response rate could not be calculated because the total number of invited SICOT members was unavailable.

Results: 87 surgeons from six continents participated, most with extensive clinical experience. The analysis revealed substantial heterogeneity in the frequency of local antibiotic use as well as in the selected antibiotic agents and application methods. An increase in local antibiotic use over the past decade was reported by 48/87 (55.2%) respondents. The main reported reasons for using local antibiotics were surgeon's preference (44/87, 50.6%) and intraoperative findings (26/87, 29.9%).

Conclusions: Among the surveyed SICOT respondents, local antibiotic use was reported across all represented regions, but substantial variation was observed in reported indications, antibiotic selection, and delivery methods. Given the unavailable invitation denominator and highly imbalanced regional sample sizes, these findings should be interpreted as exploratory and should not be considered evidence of treatment effectiveness or preferred practice.