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Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures

Malekpour, Mahdi MD; Bridgham, Kelly; Neuhaus, Nina MD; Widom, Kenneth MD; Rapp, Megan MD; Leonard, Diane MD; Baro, Susan DO; Dove, James BA; Hunsinger, Marie RN; Blansfield, Joseph MD; Shabahang, Mohsen MD; Torres, Denise MD; Wild, Jeffrey MD

doi: 10.1097/SCS.0000000000002724
Original Articles

Abstract: Facial fractures are commonly managed nonoperatively. Patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. The aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. A total number of 289 patients who were admitted to our level I trauma center with nonoperative facial fractures from the beginning of 2012 to the end of 2014 were studied. Patients were categorized into 3 groups: no antibiotic prophylaxis, short-term antibiotic prophylaxis (1–5 days), and long-term antibiotic prophylaxis (>5 days). The primary outcome was the incidence of facial soft tissue infection and Clostridium difficile colitis. Fifty patients received no antibiotic prophylaxis. Sixty-three patients completed a short course of antibiotic prophylaxis and 176 patients received long-term antibiotics. Ampicillin/sulbactam, amoxicillin/clavulanic acid, or a combination of both were used in 216 patients. Twenty-three patients received clindamycin due to penicillin allergy. Short and long courses of antibiotic prophylaxis were administered more commonly in patients with concomitant maxillary and orbital fractures (P <0.0001). No mortality was found in any group. Soft tissue infection was not identified in any patient. C. difficile colitis was identified in 1 patient who had received a long course of antibiotic prophylaxis (P = 0.7246). There was no difference in the outcome of patients receiving short-term, long-term, and no antibiotic prophylaxis. Prospective randomized studies are needed to provide further clinical recommendations.

Section of Trauma and Acute Care Surgery, Department of Surgery, Geisinger Medical Center, Danville, PA.

Address correspondence and reprint requests to Jeffrey L. Wild, MD, Section of Trauma and Acute Care Surgery, Department of Surgery, Geisinger Medical Center, 100 North Academy Avenue, MC 21-69, Danville, PA 17822; E-mail: jlwild@geisinger.edu

Received 11 February, 2016

Accepted 29 February, 2016

Meeting Presentation: Eastern Association for the Surgery of Trauma, 2016 San Antonio.

The authors report no conflicts of interest.

© 2016 by Mutaz B. Habal, MD.