Comparing Preventive Antibiotic Regimens and Prevalence of Fracture-Related Infections Following Open Long Bone Fractures: A Two-Center Retrospective Study in Northwest Cameroon

Background: Fracture-related infection (FRI) is one of the most serious complications following open long bone fractures, resulting in prolonged hospitalization, repeated surgical procedures, increased healthcare costs, disability, and poor functional outcomes. Appropriate antibiotic prophylaxis remains a cornerstone of infection prevention, particularly in low-resource settings where standardized treatment protocols are often lacking. Objective: To compare preventive antibiotic regimens and determine the prevalence of fracture-related infection among patients with open long bone fractures managed at two tertiary hospitals in the North West Region of Cameroon. Methods: A retrospective cross-sectional study was conducted using medical records of patients with open long bone fractures treated at Nkwen Baptist Hospital and The People’s Clinic between January 2023 and January 2024. Data on patient characteristics, fracture classification, antibiotic prophylaxis, surgical management, and infection outcomes were extracted using a structured data collection tool and analyzed with SPSS version 23. Associations between study variables and fracture-related infection were evaluated at a significance level of p < 0.05. Results: Among 450 patients with long-bone fractures managed during the study period, 120 had open long-bone fractures and were screened for eligibility; 94 met the eligibility criteria and were included in the final analysis. Nineteen patients (20.2%) developed postoperative wound infections. Of these, 8 met consensus-confirmatory criteria for fracture-related infection (FRI), giving a confirmed FRI prevalence of 8.5%, while 11 were superficial wound infections and were analysed separately. Confirmed FRI occurred in 2.9% of Grade I, 5.0% of Grade II, and 25.0% of Grade III fractures, with infection increasing with fracture severity. Confirmed FRI occurred in 9.1% of patients receiving cloxacillin and 8.0% of those receiving ceftriaxone, gentamicin, and metronidazole, with no statistically significant difference between the hospital/regimen groups. Delayed surgical debridement (>6 hours) was associated with a higher occurrence of confirmed FRI. Conclusion: Postoperative wound infection remained an important complication following open long-bone fractures, although fewer than half of the postoperative infections met consensus-confirmatory criteria for FRI. Confirmed FRI was more frequent among patients with severe open fractures and those undergoing delayed surgical debridement. Confirmed FRI proportions