Final answer:
Antibiotics should be given within 60 minutes before surgical incision to reduce infection risks after open fractures. Delays can lead to increased complications such as infections and antibiotic resistance, as observed in cases of MRSA where first-line antibiotics like oxacillin are ineffective.
Step-by-step explanation:
The delay in antibiotic (abx) administration after an open fracture (fx) is crucial. A principle guideline is that prophylactic antibiotics should be administered within 60 minutes before a surgical incision to reduce the risk of postoperative infections. Delaying antibiotic treatment after an open fracture increases complications because the risk for infection rises significantly the longer the wound remains exposed to potential pathogens.
Some likely complications from delayed antibiotic treatment or inappropriate antibiotic use include wound infections, sepsis, and the development of resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). As illustrated in the case of Barbara's worsening condition despite oxacillin therapy, the infection did not respond because the causative bacterium was resistant to oxacillin, a condition frequently encountered with MRSA infections, necessitating a switch to a more effective antibiotic like vancomycin.