Antibiotic prophylaxis in open fractures should provide coverage for which contaminants?

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Open fractures expose a wound to outside contaminants, so antibiotic prophylaxis aims to cover the organisms most likely to contaminate the wound at the time of injury. That means targeting skin flora—mainly Staphylococcus aureus and Streptococcus species—as well as environmental contaminants that come from soil, water, and other external sources. Covering both groups helps prevent early infection as the wound is healing. If the injury is known to be heavily contaminated with soil or fecal material, additional anaerobic coverage may be added, but the baseline goal is to protect against skin flora and environmental organisms. Choosing prophylaxis that covers only skin flora or only anaerobes would miss part of the likely contaminating organisms, and omitting prophylaxis in an open fracture is not appropriate.