Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-02-06 DOI:10.1097/TA.0000000000004539

Rabiya K Mian, Heather M Grossman Verner, Cynthia I Villalta, Dana Farsakh, Joseph D Amos, Karen G Minoza, Rosemary Kozar, Andrew R Doben, Natasha Keric, Ernest E Moore, Claudia Alvarez, Jason Murry, Tatiana C P Cardenas, Richard H Lewis, James A Zebley, Caitlin M Blades, Gail Tominaga, Michael Charles, Michael W Cripps, Linda A Dultz, Justin Bailey, Tanya Egodage, Jin H Ra

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引用次数: 0

Abstract

Background: Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures.

Methods: A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H, Mann-Whitney U, Pearson's χ2, Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications.

Results: Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668).

Conclusion: Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures.

Level of evidence: Therapeutic/Care Management; Level II.

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.