The document discusses the use of antibiotics for open fractures. It recommends using cefazolin as the ideal antibiotic for prophylaxis due to Staphylococcus being the most common pathogen in open fractures. It provides alternatives like erythromycin, vancomycin, or combinations if the wound is very dirty. Proper administration is a single high dose pre-operatively by intravenous route. The principles of treating open fractures include assuming contamination, preventing infection through debridement, antibiotics, and early wound stabilization and coverage.

1. PEMAKAIAN ANTIBIOTIKAPEMAKAIAN ANTIBIOTIKA
PRA BEDAH PADAPRA BEDAH PADA
FRAKTUR TERBUKAFRAKTUR TERBUKA
OlehOleh
Dr.Azharuddin,SpBO-K.Spine FICSDr.Azharuddin,SpBO-K.Spine FICS
Divisi Bedah Orthopaedi FK UNSYIAH/BPK-Divisi Bedah Orthopaedi FK UNSYIAH/BPK-
RSUZA Banda AcehRSUZA Banda Aceh
20042004

5. Fr terbuka+plating 6 minggu post opFr terbuka+plating 6 minggu post op

6. PendahuluanPendahuluan
 ““AB” Profilaksis pada fraktur terbuka; infeksi.AB” Profilaksis pada fraktur terbuka; infeksi.
 Dasar Pemilihan Jenis“AB” ?Dasar Pemilihan Jenis“AB” ?
 -Kemungkinan kuman patogen yang spesifik.-Kemungkinan kuman patogen yang spesifik.
 Fraktur terbuka, kuman>> staphylococcusFraktur terbuka, kuman>> staphylococcus
 ““AB”Ideal pada fr terbuka?AB”Ideal pada fr terbuka? CEFAZOLINCEFAZOLIN

7. ALTERNATIF “AB”PROFILAKSISALTERNATIF “AB”PROFILAKSIS
 ERYTROMYCIN & VANCOMYCIN HCLERYTROMYCIN & VANCOMYCIN HCL
 KOMBINASI BENZYL PENICILLIN-KOMBINASI BENZYL PENICILLIN-
FLUCOXACILLINFLUCOXACILLIN
 LUKA SANGAT KOTOR: KOMBINASIKAN DGNLUKA SANGAT KOTOR: KOMBINASIKAN DGN
*GENTAMYCIN &*GENTAMYCIN &
*METRONIDAZOLE*METRONIDAZOLE
(UTK KUMAN GRAM(-)&ANAEROB)(UTK KUMAN GRAM(-)&ANAEROB)

8. CARA PEMBERIAN “AB”CARA PEMBERIAN “AB”
PROFILAKSISPROFILAKSIS
SATU KALI PRE OPERASISATU KALI PRE OPERASI
DOSIS TINGGIDOSIS TINGGI
SETENGAH JAM PRE OPERASISETENGAH JAM PRE OPERASI
INTRAVENOUSINTRAVENOUS

9. PRINSIP PENANGANANPRINSIP PENANGANAN
FRAKTUR TERBUKAFRAKTUR TERBUKA
 ASUMSIKAN SEMUA “GRADING” FRASUMSIKAN SEMUA “GRADING” FR
TERBUKA------TERKONTAMINASITERBUKA------TERKONTAMINASI
 CEGAH PASIEN MENJADI “INFECTED”CEGAH PASIEN MENJADI “INFECTED”
 CARA:CARA:
1.WOUND DEBRIDEMENT1.WOUND DEBRIDEMENT
2.”AB” PROFILAXIS2.”AB” PROFILAXIS
3.STABILIZATION OF THE FRACTURE3.STABILIZATION OF THE FRACTURE
4.EARLY WOUND COVER4.EARLY WOUND COVER

11. MIP0MIP0

12. INSIDEN INFEKSI FR TERBUKAINSIDEN INFEKSI FR TERBUKA
??
KORELASI DENGANKORELASI DENGAN EXTENT OF SOFTEXTENT OF SOFT
TISSUE DAMAGETISSUE DAMAGE
GRADEGRADE II : <: < 1 %1 %
GRADEGRADE III : > 10 %III : > 10 %

13. KONSEP UMUM INFEKSIKONSEP UMUM INFEKSI
MUSKULOSKELETALMUSKULOSKELETAL
 GAMBARAN KLINIS?? ------BERVARIASI,GAMBARAN KLINIS?? ------BERVARIASI,
TERGANTUNG:TERGANTUNG:
 TYPE INFEKSI(ST,BONE,JOINT)TYPE INFEKSI(ST,BONE,JOINT)
 LOKASI INFEKSILOKASI INFEKSI
 KUMAN PENYEBAB INFEKSIKUMAN PENYEBAB INFEKSI
 DELAYED IN DIAGNOSISDELAYED IN DIAGNOSIS
 DELAYEDDELAYED DLM MEMBERIKAN “AB”DLM MEMBERIKAN “AB”
 HOST FACTORHOST FACTOR

14. HAL-HAL YANG PERLUHAL-HAL YANG PERLU
DIKETAHUIDIKETAHUI
RIWAYAT TRAUMARIWAYAT TRAUMA
KONTAMINASIKONTAMINASI
RIWAYAT PENYAKIT LAINRIWAYAT PENYAKIT LAIN
FOTO POLOSFOTO POLOS
KULTUR DAN SENSITIVITY TESKULTUR DAN SENSITIVITY TES
KULTUR DARAHKULTUR DARAH

15. PENGGUNAAN “AB” RASIONALPENGGUNAAN “AB” RASIONAL
PD OPERASIPD OPERASI
 INFEKSI PASKA OPERASI → NOSOKOMIAL??INFEKSI PASKA OPERASI → NOSOKOMIAL??
 DAMPAK TERHADAP PX:DAMPAK TERHADAP PX:
* LAMA OPNAME?* LAMA OPNAME?
** COSTLYCOSTLY
** MENYUSAHKAN PX & KEL.MENYUSAHKAN PX & KEL.
 KAMAR OPERASI IDEAL ??KAMAR OPERASI IDEAL ??

16. TABEL “AB” PROFILAKSIS KASUSTABEL “AB” PROFILAKSIS KASUS
KASUS BEDAHKASUS BEDAH
Surgical procedureSurgical procedure predominant inf microorganismpredominant inf microorganism recommened agentrecommened agent dosedose
routeroute
______________________________________________________________________________________________________________________________________________________________________
CARDIO THORACICCARDIO THORACIC Staphylococci CEFAZOLIN 1-2 gStaphylococci CEFAZOLIN 1-2 g
iviv
or CEFUROXIME 1,5 g ivor CEFUROXIME 1,5 g iv
or VANCOMYCINor VANCOMYCIN
____________________________________________________________________________________________________________________________________________________________________
Non-cardiacNon-cardiac Staphylococci CEFAZOLIN or 1-2 g ivStaphylococci CEFAZOLIN or 1-2 g iv
Vascular SurgeryVascular Surgery CEFUROXIME 1,5 g ivCEFUROXIME 1,5 g iv
______________________________________________________________________________________________________________________________________________________________________
ARTHTROPLASTY OF Staphylococci CEFAZOLINARTHTROPLASTY OF Staphylococci CEFAZOLIN
1-2 g IV1-2 g IV
JOINT REPLACEMENTJOINT REPLACEMENT
OPEN REDUCTIONOPEN REDUCTION
OF FRACTURESOF FRACTURES
LOWER LIMB AMPUTATIONLOWER LIMB AMPUTATION
______________________________________________________________________________________________________________________________________________________________________

17. Gastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 gGastro duodenal Streptococci,Coliforms, CEFAZOLIN 1-2 g
iviv
anaerobic bacteria incl.anaerobic bacteria incl.
Bacteroides sppBacteroides spp
________________________________________________________________________________________________________________________________
BILIARY TRACTBILIARY TRACT Coliform, enterococci, CEFAZOLIN 2 gColiform, enterococci, CEFAZOLIN 2 g
iviv
For high risk only anaerobic bact incl. CEFOXITIN 2 gFor high risk only anaerobic bact incl. CEFOXITIN 2 g
iviv
: > 70 years Bacteroides,clostridia: > 70 years Bacteroides,clostridia
Obstr joundiceObstr joundice
Acute cholecystitisAcute cholecystitis
Acute cholangitisAcute cholangitis
Common duct stoneCommon duct stone
Low risk…… NO PROPHYLAXISLow risk…… NO PROPHYLAXIS
________________________________________________________________________________________________________________________________

18. Colon/small bowelColon/small bowel coliforms,anaerobic CEFOXITIN 2 g ivcoliforms,anaerobic CEFOXITIN 2 g iv
bacteria incl.bacteroibacteria incl.bacteroi
des fragilisdes fragilis
____________________________________________________________________________________________________________________
APPENDECTOMYAPPENDECTOMY Coliforms,anaerobic CEFOXITIN 2 g ivColiforms,anaerobic CEFOXITIN 2 g iv
bacteria incl.bacteroibacteria incl.bacteroi
des fragilisdes fragilis
____________________________________________________________________________________________________________________
PENETRATINGPENETRATING idem CEFOXITIN 2 g ividem CEFOXITIN 2 g iv
ABD TRAUMAABD TRAUMA
____________________________________________________________________________________________________________________

19. VAGINALor abdominalVAGINALor abdominal Coliformes,enterococciCEFAZOLIN 1-2 gColiformes,enterococciCEFAZOLIN 1-2 g
iviv
HysterectomyHysterectomy group B streptococcigroup B streptococci
____________________________________________________________________________________________________________________
Caesarian sectiionCaesarian sectiion with as for hysterectomy CEFAZOLIN 1 gwith as for hysterectomy CEFAZOLIN 1 g
iviv
High risk e.g prematureHigh risk e.g premature
Rupture of membranes CEFOXITIN 2 g ivRupture of membranes CEFOXITIN 2 g iv
Low risk_elective NO PROPHYLAXISLow risk_elective NO PROPHYLAXIS
____________________________________________________________________________________________________________________
ABORTIONABORTION as for hysterectomy CEFAZOLIN 1 g ivas for hysterectomy CEFAZOLIN 1 g iv
____________________________________________________________________________________________________________________
PROSTATECTOMYPROSTATECTOMY Coliforms CIPROFLOXACIN 500mgColiforms CIPROFLOXACIN 500mg
oraloral
____________________________________________________________________________________________________________________
CNS ShuntCNS Shunt Staphylococci CEFAZOLIN 1 gStaphylococci CEFAZOLIN 1 g
iviv
____________________________________________________________________________________________________________________

20. ““AB” DI BIDANGAB” DI BIDANG
MUSKULOSKELETALMUSKULOSKELETAL
 IDEAL: SETELAH ADA HASIL KULTURIDEAL: SETELAH ADA HASIL KULTUR
 LIFE OR LIMB THREATENING AB:LIFE OR LIMB THREATENING AB: SEGERA,SEGERA,
BROAD SPECTRUMBROAD SPECTRUM
 PROFILAK >< TERAPEUTIK ??PROFILAK >< TERAPEUTIK ??
 ““AB” LOKAL , TOPIKAL ??AB” LOKAL , TOPIKAL ??

21. GUIDE LINE AB PROFILAXISGUIDE LINE AB PROFILAXIS
ORTHO DI INDONESIA?ORTHO DI INDONESIA?
 DATA (-)DATA (-)
 ORTHO FK UNAIR/RS SUTOMO:ORTHO FK UNAIR/RS SUTOMO:
* GRADE I: CEFALOSPORIN I, 2 Gr* GRADE I: CEFALOSPORIN I, 2 Gr
pre op, lanjut 3 x 1-2 gr selama 1 hari.pre op, lanjut 3 x 1-2 gr selama 1 hari.
* GRADE II: CEFALOSPORIN I, 2gr* GRADE II: CEFALOSPORIN I, 2gr
Pre op, lanjut 3 x 1-2 gr selama 2 hari.Pre op, lanjut 3 x 1-2 gr selama 2 hari.
* GRADE III: CEFALOSPORIN I, 2 gr pre op, lanjut 3 x 1-2* GRADE III: CEFALOSPORIN I, 2 gr pre op, lanjut 3 x 1-2
gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.gr selama 3 hari &gentamycin 2 x 80 mg, 3 hari.

22. KESIMPULANKESIMPULAN
 DIAGNOSIS PRE OP—PENTINGDIAGNOSIS PRE OP—PENTING
 PILIHPILIH ABAB ~ PETA KUMAN SECARA EMPIRIS~ PETA KUMAN SECARA EMPIRIS
 WAKTU OP:WAKTU OP:GOLDEN PERIODE ?GOLDEN PERIODE ?
 IDEAL, CEFALOSPORIN I, BILA INFEKSIIDEAL, CEFALOSPORIN I, BILA INFEKSI
MANIFEST; CEF II, III dan GentamycinMANIFEST; CEF II, III dan Gentamycin
 IDEAL: ~ HASIL KULTUR & S TESIDEAL: ~ HASIL KULTUR & S TES

23. CEGAH INFEKSI NOSOKOMIAL !!CEGAH INFEKSI NOSOKOMIAL !!
ABAB BUKAN SATU-SATUNYA FAKTORBUKAN SATU-SATUNYA FAKTOR
YG BISA CEGAH INFEKSI.YG BISA CEGAH INFEKSI.
PERHATIKAN HAL-HAL LAIN YG ERATPERHATIKAN HAL-HAL LAIN YG ERAT
KAITAN TERHADAP KEJADIANKAITAN TERHADAP KEJADIAN
INFEKSI.INFEKSI.

24. Thank u doctor , i`m oke !!Thank u doctor , i`m oke !!

25. TERIMA KASIHTERIMA KASIH….….