Efficacy of Topical Antibiotic Powder Application in the Emergency Department on Reducing Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures: A Multicenter Study.
Mir Ibrahim Sajid, Whisper Grayson, Mitchell P John, Shea Taylor, Bradley J Lauck, Zohair Zaidi, Alex Savage, Nicole Griffin, Mohamed Awad, Andrew T Chen, John Hwang, Nicholas Alfonso, Hassan R Mir
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引用次数: 0
Abstract
Objectives: Deep fracture-related infections (FRIs) are a common complication of type III open lower extremity fractures, resulting in notable patient morbidity. The purpose of this study was to determine whether topical application of antibiotic (ABX) powder to type III open lower extremity fracture wounds upon presentation to the emergency department (ED) reduces the rate of FRI.
Methods: This is a retrospective review of ABX powder application compared with a historical cohort at 4 level 1 trauma centers. Patients with type III open lower extremity fractures from July 1, 2019, to October 1, 2022, who received topical ABX powder (1 g vancomycin and 1.2 g tobramycin) in the ED were compared with patients from a 4-year historical cohort who were treated through the same protocol without topical ABX powder. Outcomes include the development of FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed in addition to FRI.
Results: One hundred fifteen patients received topical ABX powder in the ED and were compared with 135 patients who were treated without topical ABX powder. The rate of FRI in the intervention group was 8 of 115 (6.96%) vs. 22 of 135 (16.30%) in the control cohort (P = 0.024). Multivariate regression analysis demonstrated higher body mass index as a risk factor for the development of FRI (P = 0.003). When excluding those with intraoperative ABX powder use, there was still a markedly lower rate of FRI when ED ABX powder was used on regression analysis (P = 0.048).
Conclusion: Antibiotic powder application to type III open fracture wounds in the ED markedly reduces the incidence of FRI in this multicenter study. Further large-scale studies are warranted.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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