Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial.

IF 3.7 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2025-04-01 Epub Date: 2025-02-06 DOI:10.1097/TA.0000000000004539

Rabiya K Mian, Heather M Grossman Verner, Cynthia I Villalta, Dana Farsakh, Joseph D Amos, Karen G Minoza, Rosemary Kozar, Andrew R Doben, Natasha Keric, Ernest E Moore, Claudia Alvarez, Jason Murry, Tatiana C P Cardenas, Richard H Lewis, James A Zebley, Caitlin M Blades, Gail Tominaga, Michael Charles, Michael W Cripps, Linda A Dultz, Justin Bailey, Tanya Egodage, Jin H Ra

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Abstract

Background: Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures.

Methods: A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H , Mann-Whitney U , Pearson's χ 2 , Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications.

Results: Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications ( p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668).

Conclusion: Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures.

Level of evidence: Therapeutic/Care Management; Level II.

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创伤患者非手术性面部骨折的预防性抗生素使用：一项前瞻性AAST多中心试验

背景：颅面创伤每年影响美国约300万人。从历史上看，总体数据质量低和样本量不足限制了面部骨折预防性抗生素使用临床实践指南的发展。我们试图研究目前预防性抗生素在非手术性面部骨折中的使用模式和效果。方法：对2022年1月至2023年12月19个中心的成人非手术性面部骨折患者进行前瞻性分析。采用Kruskal-Wallis H、Mann-Whitney U、Pearson χ2、Fisher精确检验和logistic回归模型评估抗生素使用时间（不使用抗生素、≤24小时和≤24小时）与面部骨折相关感染并发症的关系。结果：1835例患者中，1168例（63.7%）未使用抗生素，667例（36.4%）使用抗生素(≤24 h, n = 264例（14.4%）；>24小时，n = 403（22.0%）。19例（1.0%）患者出现感染并发症（未使用抗生素组为0.7%，使用抗生素组为1.7%）。尽管大多数患者（63.7%）未使用抗生素，但大多数患者（99.0%）未发生感染。损伤主要为闭合性骨折（86.3%），无粘膜破裂（83.9%）或异物（97.7%）。抗生素给药与感染并发症的发生有统计学意义（p = 0.050）。然而，经多变量logistic回归校正混杂因素(≤24小时：校正优势比，1.24；95%置信区间为0.30-5.14；P = 0.766；>24小时：调整后优势比1.32；95%置信区间为0.37-4.69；P = 0.668)。结论：尽管大多数患者未接受抗生素治疗，但感染率仍然很低。这表明预防性使用抗生素并不能降低大多数损伤类型骨折相关感染的风险。虽然随机试验是验证这些数据的最佳方法，但目前还没有证据支持抗生素治疗闭合性非手术性面部骨折。证据水平：治疗/护理管理；II级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.