Comparing piperacillin/tazobactam to current guidelines for the treatment of open fractures: A systematic review

Abstract

Background

Current guidelines call for the use of a first-generation cephalosporin with or without an aminoglycoside for the treatment of open fractures. Due to its superior safety profile and single-dose administration, Piperacillin/tazobactam (PT) may be an effective alternative. The present systematic literature review aimed to evaluate the hypothesis that PT antibiotic prophylaxis does not differ in clinical outcomes as compared to the current guidelines in the treatment of open fractures.

Methods

Five databases were queried for literature pertaining to PT administration for open fractures. A 2-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Methodologic index for non-randomized studies criteria was used to objectively assess the methodologic quality of the studies reviewed. Retrospective cohort studies that compared PT to current guidelines in open fractures were included.

Results

Four retrospective cohort studies consisting of 752 patients were included. The injury severity score (ISS) score was higher for the PT group, 18.1, versus the control group, 14.5 (p = .0008). Seventy-eight patients developed a surgical site infection (SSI) in the PT group versus 67 patients in the control group (p = .82). Twenty-one patients developed an acute kidney injury (AKI) in the PT group versus 19 in the control group (p = .51). There was no difference in the number of patients who developed resistant pathogens (6 (PT group) vs. 1 (control group); p = .99). Length of stay was greater in the PT group, 16.4 days, compared to the control group, 10.5 days (p=<0.00001).

Conclusion

The use of piperacillin/tazobactam for open fractures does not differ from first-generation cephalosporins with or without an aminoglycoside in regard to SSI, AKI, return to operating room, 1-year mortality, non-union, and development of resistant pathogens. LOS was significantly longer in the PT group but may be explained by a greater ISS. PT may be a non-inferior alternative to current guidelines due to its better safety profile and single-dose administration method, however, this review is limited by the lack of side effect reporting and underscores the need for larger prospective studies that compare side effect profiles between PT and control groups.