David Okhuereigbe, Michael Raffetto, Vivian Li, Alice Bell, Joshua E Lawrence, Joanna Kim, Christina A Stennett, Gerard P Slobogean, Nathan N O'Hara, Robert V O'Toole
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The effect of time of delivery of antibiotics was compared in 3 analyses: as a continuous variable, before vs after 60 minutes, and before vs after 180 minutes. The study analysis accounted for known confounders for infection, including Injury Severity Score (ISS), GA classification, and wound contamination.</p><p><strong>Results: </strong>The study population included 191 patients with a mean age of 44 years (SD: 17) and 153 males. The median time from arrival to the first antibiotic was 44 minutes (IQR: 21-147). The majority of patients (99.0%) received cephazolin as their initial antibiotic. The overall 90-day risk of deep surgical site infection requiring irrigation and debridement was 10.5%. The timing of antibiotic administration as a continuous variable was not associated with infection (aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39). Similarly, time to antibiotic administration was not associated with infection at thresholds of 1 hour (aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96) or 3 hours (aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89) in separate models.</p><p><strong>Conclusions: </strong>Early antibiotic administration was not associated with a reduced risk of deep surgical site infection in GA type III tibia fractures. 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引用次数: 0
摘要
目的：探讨gustillo - anderson (GA) III型开放性胫骨骨折患者急诊给药时机与深部手术部位感染的关系。方法：设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：纳入2016年至2021年年龄≥18岁的Gustilo-Anderson (GA) III型开放性胫骨骨折（OTA/AO 41、42或43）患者。结果测量和比较：结果为深部手术部位感染，需要冲洗和清创。在连续变量、给药前与给药后60分钟、给药前与给药后180分钟3个分析中比较抗生素给药时间的影响。研究分析考虑了感染的已知混杂因素，包括损伤严重程度评分（ISS）、GA分类和伤口污染。结果：研究人群包括191例患者，平均年龄44岁（SD: 17），男性153例。从到达到第一个抗生素的中位时间为44分钟（IQR: 21-147）。大多数患者（99.0%）最初使用头孢唑啉作为抗生素。需要冲洗和清创的90天深部手术部位感染的总体风险为10.5%。抗生素给药时间作为一个连续变量与感染无关（aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39）。同样，在不同的模型中，在阈值为1小时（aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96）或3小时（aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89）时，给药时间与感染无关。结论：早期抗生素治疗与GA III型胫骨骨折深部手术部位感染风险降低无关。这些结果表明，抗生素的急性时机可能不像以前认为的那样对患者的感染风险有影响。证据等级：治疗性，III级。
Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia Fractures.
Objectives: To determine the association between the timing of antibiotic delivery in the emergency department (ED) and deep surgical site infection in Gustilo-Anderson (GA) type III open tibia fractures.
Methods: Design: Retrospective cohort study.
Setting: Single Level I Trauma Center.
Patient selection criteria: Patients aged ≥18 years with a Gustilo-Anderson (GA) type III open tibia fracture (OTA/AO 41, 42, or 43) from 2016 to 2021 were included.
Outcome measures and comparisons: The outcome was deep surgical site infection requiring irrigation and debridement. The effect of time of delivery of antibiotics was compared in 3 analyses: as a continuous variable, before vs after 60 minutes, and before vs after 180 minutes. The study analysis accounted for known confounders for infection, including Injury Severity Score (ISS), GA classification, and wound contamination.
Results: The study population included 191 patients with a mean age of 44 years (SD: 17) and 153 males. The median time from arrival to the first antibiotic was 44 minutes (IQR: 21-147). The majority of patients (99.0%) received cephazolin as their initial antibiotic. The overall 90-day risk of deep surgical site infection requiring irrigation and debridement was 10.5%. The timing of antibiotic administration as a continuous variable was not associated with infection (aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39). Similarly, time to antibiotic administration was not associated with infection at thresholds of 1 hour (aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96) or 3 hours (aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89) in separate models.
Conclusions: Early antibiotic administration was not associated with a reduced risk of deep surgical site infection in GA type III tibia fractures. These results suggest that the acute timing of antibiotics may not be as impactful to patients' risk of infection as once considered.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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