{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:52:43Z","timestamp":1789692763735,"version":"4.0.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"DOI":"10.13039\/501100005296","name":"Universit\u00e4tsklinikum Regensburg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005296","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Unfallchirurgie"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic prophylaxis is a\u00a0key component of infection prevention in trauma and orthopedic surgery. Until 2024, no uniform nationwide guidelines existed in Germany regarding the optimal choice, dosage, and duration of perioperative antibiotic use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A\u00a0nationwide survey was conducted among 36\u00a0German trauma and orthopedic centers to assess current practices of antibiotic prophylaxis in closed and open fractures, primary arthroplasty, and posterior spinal instrumentation. The questionnaire included the choice and duration of systemic antibiotics, empirical strategies, and the use of local antibiotics such as vancomycin powder. The current practice was then compared to the recently published S3-guideline \u201cPerioperative and periinterventional antibiotic prophylaxis\u201d (AWMF 067-009;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/register.awmf.org\/de\/leitlinien\/detail\/067-009\" ext-link-type=\"uri\">https:\/\/register.awmf.org\/de\/leitlinien\/detail\/067-009<\/jats:ext-link>\n                      ) in Germany.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For closed fractures, 94.4% of hospitals used first- or second-generation cephalosporins, with single-shot administration. In Gustilo\u2013Anderson (GA) type\u00a0I\u00a0open fractures, cefuroxime and ampicillin\/sulbactam were each used by 13\u00a0hospitals (36.1%), with 63.9% applying a\u00a0single-shot regimen. In type\u00a0III open fractures, piperacillin\/tazobactam was most common (33.3%), and 72\u202fh prophylaxis was most frequently reported in both type\u00a0II and\u00a0III fractures (38.9%). In distal phalanx fractures, 94.4% of hospitals administered systemic antibiotics despite guideline recommendations to omit prophylaxis when no osteosynthesis is required. In arthroplasty, cefuroxime (50.0%) and cefazolin (41.7%) predominated, with single-shot use in 94.4%. In spine surgery, 38.9% additionally used local vancomycin powder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While guideline adherence is high in routine indications, significant deviations remain in open fractures and distal phalanx fractures of the fingers. Extended prophylaxis beyond 72\u202fh in GA type\u00a0III fractures and the frequent use of antibiotics in distal phalanx injuries contrast with current recommendations. Stronger implementation of national standards is essential to reduce overtreatment and support antimicrobial stewardship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphic abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00113-025-01659-7","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T05:54:09Z","timestamp":1764914049000},"page":"123-130","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antibiotic prophylaxis in trauma and orthopedic surgery","Antibiotikaprophylaxe in der Unfallchirurgie und Orthop\u00e4die"],"prefix":"10.1007","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5326-7273","authenticated-orcid":false,"given":"Susanne","family":"Baertl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegmund","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopold","family":"Henssler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hanses","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Alt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"1659_CR1","unstructured":"Abele-Horn M, Novotny A, Bader L et\u00a0al Perioperative und periinterventionelle antibiotikaprophylaxe (PAP). https:\/\/register.awmf.org\/de\/leitlinien\/detail\/067-009"},{"key":"1659_CR2","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1302\/2046-3758.106.BJR-2021-0167.R1","volume":"10","author":"S Baertl","year":"2021","unstructured":"Baertl\u00a0S, Metsemakers\u00a0W\u2011J, Morgenstern\u00a0M et\u00a0al (2021) Fracture-related infection. Bone Joint Res 10:351\u2013353. https:\/\/doi.org\/10.1302\/2046-3758.106.BJR-2021-0167.R1","journal-title":"Bone Joint Res"},{"key":"1659_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-022-01200-0","volume-title":"Antibiotikaeinsatz zu Prophylaxe und empirischer Therapie von frakturassoziierten Infektionen in Deutschland: Eine Umfrage an 44\u00a0Kliniken. Unfallchirurgie","author":"S B\u00e4rtl","year":"2022","unstructured":"B\u00e4rtl\u00a0S, Walter\u00a0N, Lang\u00a0S et\u00a0al (2022) Antibiotikaeinsatz zu Prophylaxe und empirischer Therapie von frakturassoziierten Infektionen in Deutschland: Eine Umfrage an 44\u00a0Kliniken. Unfallchirurgie https:\/\/doi.org\/10.1007\/s00113-022-01200-0"},{"key":"1659_CR4","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/S1473-3099(18)30605-4","volume":"19","author":"A Cassini","year":"2019","unstructured":"Cassini\u00a0A, H\u00f6gberg\u00a0LD, Plachouras\u00a0D et\u00a0al (2019) Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a\u00a0population-level modelling analysis. Lancet Infect Dis 19:56\u201366. https:\/\/doi.org\/10.1016\/S1473-3099(18)30605-4","journal-title":"Lancet Infect Dis"},{"key":"1659_CR5","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.N.00088","author":"Y Chang","year":"2015","unstructured":"Chang\u00a0Y, Kennedy\u00a0SA, Bhandari\u00a0M et\u00a0al (2015) Effects of antibiotic prophylaxis in patients with open fracture of the extremities: a\u00a0systematic review of randomized controlled trials. JBVS Rev. https:\/\/doi.org\/10.2106\/JBJS.RVW.N.00088","journal-title":"JBVS Rev"},{"key":"1659_CR6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s00402-020-03474-8","volume":"141","author":"P Declercq","year":"2021","unstructured":"Declercq\u00a0P, Zalavras\u00a0C, Nijssen\u00a0A et\u00a0al (2021) Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures. Arch Orthop Trauma Surg 141:235\u2013243. https:\/\/doi.org\/10.1007\/s00402-020-03474-8","journal-title":"Arch Orthop Trauma Surg"},{"key":"1659_CR7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000244.pub2","author":"WJ Gillespie","year":"2010","unstructured":"Gillespie\u00a0WJ, Walenkamp\u00a0GH (2010) Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD000244.pub2","journal-title":"Cochrane Database Syst Rev"},{"key":"1659_CR8","doi-asserted-by":"publisher","first-page":"105","DOI":"10.2147\/IDR.S390837","volume":"16","author":"W Hu","year":"2023","unstructured":"Hu\u00a0W, Wang\u00a0H, Wu\u00a0X et\u00a0al (2023) Does the Microflora of surgery site infection change after prophylactic use of Vancomycin powder in the spine surgery. IDR 16:105\u2013113. https:\/\/doi.org\/10.2147\/IDR.S390837","journal-title":"IDR"},{"key":"1659_CR9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1530\/EOR-21-0077","volume":"7","author":"H Luo","year":"2022","unstructured":"Luo\u00a0H, Ren\u00a0Y, Su\u00a0Y et\u00a0al (2022) Intraoperative vancomycin powder to reduce surgical site infections after posterior spine surgery: a\u00a0systematic review and meta-analysis. EFORT Open Rev 7:109\u2013121. https:\/\/doi.org\/10.1530\/EOR-21-0077","journal-title":"EFORT Open Rev"},{"key":"1659_CR10","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1089\/sur.2017.108","volume":"18","author":"J Messner","year":"2017","unstructured":"Messner\u00a0J, Papakostidis\u00a0C, Giannoudis\u00a0PV, Kanakaris\u00a0NK (2017) Duration of administration of antibiotic agents for open fractures: meta-analysis of the existing evidence. Surg Infect 18:854\u2013867. https:\/\/doi.org\/10.1089\/sur.2017.108","journal-title":"Surg Infect"},{"key":"1659_CR11","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1177\/1753193415601055","volume":"41","author":"D Metcalfe","year":"2016","unstructured":"Metcalfe\u00a0D, Aquilina\u00a0AL, Hedley\u00a0HM (2016) Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J\u00a0Hand Surg Eur Vol 41:423\u2013430. https:\/\/doi.org\/10.1177\/1753193415601055","journal-title":"J Hand Surg Eur Vol"},{"key":"1659_CR12","doi-asserted-by":"publisher","first-page":"S104","DOI":"10.1016\/S0020-1383(15)30027-9","volume":"46","author":"R Otchwemah","year":"2015","unstructured":"Otchwemah\u00a0R, Grams\u00a0V, Tjardes\u00a0T et\u00a0al (2015) Bacterial contamination of open fractures\u2014pathogens, antibiotic resistances and therapeutic regimes in four hospitals of the trauma network cologne, Germany. Injury 46:S104\u2013S108. https:\/\/doi.org\/10.1016\/S0020-1383(15)30027-9","journal-title":"Injury"},{"key":"1659_CR13","doi-asserted-by":"publisher","first-page":"2007","DOI":"10.1177\/21925682211068414","volume":"13","author":"D Tkatschenko","year":"2023","unstructured":"Tkatschenko\u00a0D, Hansen\u00a0S, Koch\u00a0J et\u00a0al (2023) Prevention of surgical site infections in spine surgery: an international survey of clinical practices among expert spine surgeons. Global Spine\u00a0J 13:2007\u20132015. https:\/\/doi.org\/10.1177\/21925682211068414","journal-title":"Global Spine J"},{"key":"1659_CR14","doi-asserted-by":"publisher","DOI":"10.4414\/smf.2023.09299","author":"I Ukay","year":"2023","unstructured":"Ukay\u00a0I, Strahm\u00a0C, Vogt\u00a0M et\u00a0al (2023) Antibiotikaprophylaxe \/ Pr\u00e4emptive Therapie bei offenen Frakturen in der Orthop\u00e4die. Swiss Med Forum. https:\/\/doi.org\/10.4414\/smf.2023.09299","journal-title":"Swiss Med Forum"},{"key":"1659_CR15","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.jocn.2018.03.023","volume":"52","author":"R Yao","year":"2018","unstructured":"Yao\u00a0R, Tan\u00a0T, Tee\u00a0JW, Street\u00a0J (2018) Prophylaxis of surgical site infection in adult spine surgery: a\u00a0systematic review. J\u00a0Clin Neurosci 52:5\u201325. https:\/\/doi.org\/10.1016\/j.jocn.2018.03.023","journal-title":"J Clin Neurosci"},{"key":"1659_CR16","first-page":"327","volume":"81","author":"E Yusuf","year":"2015","unstructured":"Yusuf\u00a0E, Steinr\u00fccken\u00a0J, Buchegger\u00a0T et\u00a0al (2015) A descriptive study on the surgery and the microbiology of Gustilo type\u00a0III fractures in an university hospital in Switzerland. Acta Orthop Belg 81:327\u2013332","journal-title":"Acta Orthop Belg"},{"key":"1659_CR17","volume-title":"EPRD Endoprothesenregister","author":"EPRD Jahresbericht","year":"2023","unstructured":"EPRD Jahresbericht (2023) EPRD Endoprothesenregister. DE, Deutschland"}],"container-title":["Die Unfallchirurgie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00113-025-01659-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00113-025-01659-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00113-025-01659-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T15:14:31Z","timestamp":1769786071000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00113-025-01659-7"}},"subtitle":["Current practices across 36\u00a0German hospitals and comparison with recently published national guidelines","Aktuelle Praxis in 36\u00a0deutschen Krankenh\u00e4usern und ein Vergleich mit der k\u00fcrzlich publizierten nationalen Leitlinie"],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":17,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["1659"],"URL":"https:\/\/doi.org\/10.1007\/s00113-025-01659-7","relation":{},"ISSN":["2731-7021","2731-703X"],"issn-type":[{"value":"2731-7021","type":"print"},{"value":"2731-703X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"assertion":[{"value":"21 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"S.\u00a0Baertl, S.\u00a0Lang, L.\u00a0Henssler, L.\u00a0Huber, M.\u00a0Rupp, F.\u00a0Hanses and V.\u00a0Alt declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No studies involving human participants or animals were conducted by the authors for this article. For all other cited studies, the respective ethical guidelines as stated in those sources apply.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}