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Surgical Site Infections in Patients With Type 3 Open Fractures

Comparing Antibiotic Prophylaxis With Cefazolin Plus Gentamicin Versus Piperacillin/Tazobactam

Redfern, Jenessa Pharm D; Wasilko, Scott M. MD; Groth, Meghan E. Pharm D; McMillian, Wesley D. Pharm D; Bartlett, Craig S. III MD

doi: 10.1097/BOT.0000000000000554
Original Article
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Objectives: The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis.

Design: Retrospective cohort study.

Setting: Level 1 trauma center.

Patients: Seven hundred sixty-six patients admitted between January 1, 2004, and December 31, 2012, with open fractures were identified using the National Trauma Data Bank by searching International Classification of Diseases, Ninth Revision (ICD-9) codes. Electronic medical record review revealed 134 patients with type 3 open fractures, of which 72 were included in the final analysis.

Intervention: Administration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis.

Main Outcome Measurements: SSI, nonunion, death, and rehospitalization rates at 1 year.

Results: Surgical site infection at 1 year occurred in 12 of 37 patients (32.4%) in the cefazolin plus gentamicin group and 11 of 35 patients (31.4%) in the piperacillin/tazobactam group (P = 1.000). Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups. Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group (21.6% vs. 11.4%; P = 0.246).

Conclusions: At our institution, use of piperacillin/tazobactam as compared with cefazolin plus gentamicin for antibiotic prophylaxis in patients with type 3 open fractures showed similar rates of SSI, nonunion, mortality, and rehospitalization at 1 year after injury.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Pharmacy, University of Vermont Medical Center, Burlington, VT; and

Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT.

Reprints: Craig S. Bartlett III, MD, Orthopaedic Trauma Service, Orthopaedic Specialty Center, 192 Tilley Dr, South Burlington, VT 05403 (e-mail: Craig.Bartlett@uvmhealth.org).

The authors report no conflict of interest.

Accepted January 19, 2016

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