Trends in open tibia fracture antibiotic prophylaxis

Purpose

Prophylactic antibiotics are an effective intervention in reducing fracture related infection (FRI) in open fractures after orthopaedic trauma. Despite routine antibiotic use, the rate of FRI in Gustilo Anderson (GA) type III open fractures remains high; henceforth, we investigated the rate of open tibia fractures and trends in prophylactic antibiotic usage at our institution.

Methods

This was a retrospective study of 133 type III open tibia fractures treated at an academic tertiary level I trauma center over a 15-year period (2007–2021). We collected information on administered prophylactic antibiotics, local antibiotics, soft tissue coverage, and FRI. Chi-squared tests analyzed trends in antibiotic utilization and FRI. Multivariable logistic regression was performed to evaluate association between GA type, prophylactic antibiotics, local antibiotics, and flap coverage with FRI outcomes.

Results

Analysis revealed a higher percentage of 1st/2nd generation cephalosporin use among type IIIA compared to IIIB/IIIC fractures (p < 0.001), an increase in utilization of 3rd generation cephalosporins over the 15-year period (p = 0.018), and decline in 1st/2nd generation cephalosporins. FRIs occurred in 24.8% (n = 26) of type III open tibia fractures. On multivariable logistic regression analysis, when controlling for GA type, prophylactic antibiotic regimen, and flap coverage: local antibiotic use was the only independent predictor of FRI (OR 9.3, 95% CI = 3.0-28.7, p < 0.001). When evaluating patients with adequate follow-up, local antibiotics remained the only independent predictor of FRI (OR 9.4, 95% CI 2.9–30.1, p < 0.001).

Conclusion

Institutional protocols for orthopaedic care and hospital-wide education may be beneficial to improve recognition and appropriate prophylactic treatment of high-risk open fractures.