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Facing the facts on prophylactic antibiotics for facial fractures

1 day or less

Zosa, Brenda M., MD; Elliott, Charles W.; Kurlander, David E., MD; Johnson, Freedom, MD; Ho, Vanessa Phillis, MD; Claridge, Jeffrey A., MD

Journal of Trauma and Acute Care Surgery: September 2018 - Volume 85 - Issue 3 - p 444–450
doi: 10.1097/TA.0000000000002009
2016 AAST PODIUM PAPER
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BACKGROUND To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours).

METHODS Adults admitted (2010–2015) to a Level I trauma center intensive care unit with at least one facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis. Multivariate logistic regression and analysis of propensity score matched pairs were performed.

RESULTS A total of 403 patients were included, 85.6% had blunt injuries and 72.7% had their facial fracture managed nonoperatively. The H/N infection rate was 11.2%. Two hundred eighty patients received a short course of antibiotics and 123 patients received an extended course. Median Injury Severity Score was 14 in both groups (p = 0.78). Patients receiving an extended course of antibiotics had higher rates of H/N infection (20.3% vs. 7.1%, p < 0.001). Factors associated with development of H/N infection included younger age, penetrating injury, open fracture, upper face or mandible fracture, fractures in multiple facial thirds, vascular injury, hypertension, and extended antibiotic course. Multivariate logistic regression identified younger age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–1.00; p = 0.02), multiple facial third fractures (OR, 4.9; 95% CI, 2.4–10.2; p < 0.001), and penetrating mechanism (OR, 3.1; 95% CI, 1.5–6.4; p = 0.003) as independent predictors of H/N infection, but not antibiotic duration. Propensity score-matched analysis found no differences in H/N infection between short and extended antibiotic courses (11.4% vs. 12.5%; p = 1.0). Subgroup analyses demonstrated no differences in H/N infection between short or extended antibiotic courses by injury pattern, mechanism, or treatment (operative or nonoperative).

CONCLUSION These results lead us to believe that we should limit antibiotics to 24 hours or less upon admission for facial fractures.

LEVEL OF EVIDENCE Therapeutic/care management, level IV.

From the Department of Surgery (B.M.Z., C.W.E., D.E.K., F.J., V.P.H., J.A.C.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Submitted: July 30, 2016, Revised: May 8, 2018, Accepted: May 28, 2018, Published online: July 6, 2018.

This work was presented as a podium presentation at the 75th Annual Meeting in Waikoloa, HI in September, 2016.

Address for reprints: Jeffrey A. Claridge, MD, FACS, Hospital Service Line and Division of Trauma, Critical Care, Burns, and Acute Care Surgery at MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998; email: jclaridge@metrohealth.org.

© 2018 Lippincott Williams & Wilkins, Inc.