Erica Sercy, MSPH
Epidemiologist
Trauma Research LLC, United States
Disclosure information not submitted.
Jennifer Pekarek, BSN, RN, CCRP, TCRN
Clinical Researcher
Centura Health St. Anthony Hospital, United States
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Joanne Smith, PharmD, BCCCP
Critical Care Pharmacist
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
Claire Swartwood, PharmD, BCPS
Infectious Disease Pharmacist
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
Ross Varga, PharmD, BCPS
Clinical Pharmacist
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
Eric Whittenburg, PharmD, BCCCP
Director of Clinical Pharmacy
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
David Hamilton, MD
Trauma Medical Director
Centura Health Penrose Hospital, United States
Disclosure information not submitted.
Leonid Grossman, MD
Orthopedic Surgeon
Centura Health St. Anthony Hospital, United States
Disclosure information not submitted.
Title: Duration of Antibiotic Prophylaxis in Long-Bone Open Fractures
Introduction: The Eastern Association for the Surgery of Trauma (EAST) guidelines recommend administration of systemic antibiotics to cover gram-positive organisms in type I and II fractures for 24 hours after injury, both gram-positive and gram-negative in type III for 72 hours, and duration should be no more than 24 hours after soft tissue coverage for all types. Shorter durations of prophylactic antibiotics have been shown to have similar rates of infections as longer prophylaxis. The primary aim of this study was to elucidate adherence to the EAST guideline recommendations for duration of antibiotics in patients with long-bone open fracture at two level I trauma centers.
Methods: This was a multicenter, retrospective, descriptive analysis of open fracture antibiotic prophylaxis duration. Trauma registries and electronic medical records were used to identify patients over 18 years old with an admission for long-bone open fracture and greater than 72-hour hospital length of stay. The primary outcome was adherence to duration of antimicrobial therapy recommendations from the EAST guidelines in long-bone open fractures. Secondary outcomes were incidence of acute kidney injury (AKI) and Clostridioides difficile infection (CDI) during antibiotic therapy, as well as incidence of bacterial growth from open fracture wound cultures.
Results: Of a total of 185 patients included in this study, 85 (46%) were concordant with EAST guideline recommendations for duration of antibiotic prophylaxis, including 43 (41%) with grade I or II fractures and 42 (53%) with grade III fractures. Median duration of antibiotic therapy was 3 days (IQR 2-6). AKI developed in 11 (6%) patients and CDI occurred in 2 (1%) patients. Bacteria grew in the wound cultures of 5 (3%) patients. Subgroup analysis showed that duration non-concordance was associated with significantly longer hospital length of stay (5 days vs 10 days, p< 0.01), higher injury severity scores (10 vs 14, p< 0.05), and more humerus fractures (n=3 vs n=16, p < 0.01).
Conclusion: Durations of antibiotic prophylaxis for long-bone open fractures were longer than recommended by EAST guidelines in more than half of patients. Non-concordance was significantly associated with longer hospital length of stay, more severe injuries, and humerus fracture.