Vanessa Pellegrino
Carilion Roanoke Memorial Hospital
Roanoke, VA
Disclosure information not submitted.
Madalyn Motes, PharmD
Dr. Madalyn Motes
Carilion Clinic
Roanoke, United States
Disclosure information not submitted.
Bradford McDaniel, PharmD, BCPS, BCCCP
Dr. Bradford McDaniel
Carilion Clinic, United States
Disclosure information not submitted.
Jessica Schad, PharmD, BCPS
Dr. Jessica Schad
Carilion Clinic, United States
Disclosure information not submitted.
Kelly McAllister, PharmD, MBA, BCPS
Dr. Kelly McAllister
Carilion Clinic, United States
Disclosure information not submitted.
Daniel Lollar, MD
Dr. Daniel Lollar
Carilion Clinic, United States
Disclosure information not submitted.
Franco Coniglione, MD
Dr. Franco Coniglione
Carilion Clinic, United States
Disclosure information not submitted.
Title: Evaluation of Type III Open Fracture Management With Cefazolin Plus Gentamicin Versus Cefepime
Introduction: Infection is a high-risk complication of open fractures for which empiric antibiotics should be administered within one hour of injury per the EAST guidelines. The goal of this study was to compare the efficacy and safety of cefazolin (CFZ) plus gentamicin (GEN) versus cefepime (FEP) in patients with Gustilo Type III open fractures and elucidate which organisms are drivers for infection.
Methods: This was a single-center, retrospective, quasi-experimental study of Type III open fracture patients receiving at least one dose of prophylactic antibiotics with either CFZ/GEN or FEP between November 2017 and May 2021. Outcomes included incidence of confirmed infection at 90 days and six months, causative pathogens of open-fracture related infections, time to antibiotics, and antibiotic-associated adverse events.
Results: This study included 118 patients, 46 of whom received CFZ/GEN and 72 received FEP. In the CFZ/GEN group, 32.6% of patients had a confirmed infection at 90 days, compared to 23.9% of patients in the FEP group (p=0.307). At six months, confirmed infection rates were 37% and 23.9% in the CFZ/GEN and FEP groups, respectively (p=0.133). Of those with confirmed infection and culture documentation, methicillin-resistant Staphylococcus aureus occurred in 5 patients in the CFZ/GEN group, compared to 3 patients in the FEP group (p=0.162). Pseudomonas aeruginosa occurred less often, affecting 2 patients in each group (p=0.382). Median time from arrival to initial antibiotic (FEP or CFZ) was similar and within one hour for both groups. However, median time from arrival to full antibiotic regimen to include GEN in the CFZ/GEN group was prolonged to 161 minutes, compared to 24 minutes in the FEP group (p=< 0.0001). A sub-group analysis of documented infection at 90 days for those who received the full antibiotic regimen >1 hour showed higher infection rates in the CFZ/GEN group compared to the FEP group (87.5% vs. 28.6%, p=0.0004). Higher rates of acute kidney injury were seen in the CFZ/GEN group (21.7% vs. 13.9%, p=0.268).
Conclusions: FEP and CFZ/GEN appear to have similar efficacy and safety. However, time from arrival to full antibiotic regimen administration was significantly shorter with FEP compared to CFZ/GEN regimens that require pharmacy admixture and may have led to lower rates of infection.