.jpg "Nicole Leshko, BS, PharmD photo")
Nicole Leshko, BS, PharmD
Penn Presbyterian Medical Center
Philadelphia, Pennsylvania
Disclosure information not submitted.
Amanda Binkley, PharmD, AAHIVP
Clinical Pharmacy Specialist, Infectious Diseases
Penn Presbyterian Medical Center, United States
Disclosure information not submitted.
Lauren Schmidt, PharmD, BCCCP
Clinical Pharmacy Specialist, Critical Care
Penn Presbyterian Medical Center
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Characterization of Antibiotic Prophylaxis in Traumatic Facial Fractures at a Level I Trauma Center
INTRODUCTION/HYPOTHESIS: While prophylactic antibiotics may reduce the risk of infection and promote healing in select traumatic facial fractures, recent guidelines recommend against routine the use in non-operative management as well as continuation for beyond 24 hours in the operative setting. At our institution, a lack of standardization has been observed with antibiotic prophylaxis in traumatic facial fractures as it relates to fracture type and duration of therapy. The objective of this study was to characterize antibiotic prophylaxis use within this population.
Methods: This retrospective study included patients admitted between June 2018-2020 with traumatic facial fractures due to blunt or penetrating injury and receipt of prophylactic antibiotics. The primary objective assessed the use of antibiotic prophylaxis as it relates to type and duration in non-surgical and surgical management. Secondary outcomes evaluated the incidence of infection at the fracture site(s), infections attributed to antibiotic exposure, and the cost of total antibiotic use. Data was analyzed through descriptive statistics.
Results: Of 107 patients screened, 63 were included. Baseline characteristics consisted of a majority male (64%) population aged 45 + 20 years with fractures due to blunt injury (89%). The median number of fractures per patient was 4 [2-8] commonly located in orbital (25%), maxillary (24%), and nasal (17%) areas and managed non-surgically (60%). Most patients (52%) received a median inpatient course of < 5 days; of this cohort, 59% received an outpatient course for an additional > 7 days. Patients undergoing surgical fixation received a longer median inpatient course compared to those treated non-surgically (10 vs 4 days). The average patient spent $224 for an antibiotic course. No documented infections were identified at the site(s) of injury. Two patients were diagnosed with Clostridioides difficile.
Conclusion: Patients with traumatic facial fractures were likely to receive extended prophylaxis for approximately eleven days more than current recommendations. Following presentation of the project results, a stewardship guideline limiting prophylaxis to the peri-operative setting was implemented. Future steps include post-implementation assessment of the guideline.