Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less
| Autor: | David E. Kurlander, Brenda M. Zosa, Charles W Elliott, Freedom Johnson, Jeffrey A. Claridge, Vanessa P. Ho |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Facial bone Critical Illness Critical Care and Intensive Care Medicine Wounds Nonpenetrating law.invention 03 medical and health sciences Fractures Open 0302 clinical medicine Injury Severity Score Postoperative Complications law Internal medicine Mandibular Fractures medicine Humans Antibiotic prophylaxis Facial Injuries Aged Retrospective Studies Skull Fractures business.industry Soft Tissue Infections Trauma center 030208 emergency & critical care medicine 030206 dentistry Odds ratio Antibiotic Prophylaxis Middle Aged Intensive care unit Confidence interval Anti-Bacterial Agents Propensity score matching Surgery Female business |
| Zdroj: | The journal of trauma and acute care surgery. 85(3) |
| ISSN: | 2163-0763 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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