Risk Factors Associated With Open Fracture Complications Following Antibiotic Prophylaxis

The Eastern Association for the Surgery of Trauma guidelines provide antibiotic selection recommendations based on open fracture type. However, risk factors for open fracture complications (eg, infection, acute kidney injury [AKI], multi-drug resistant organisms, or Clostridioides infection [C. difficile]) and overall antibiotic prophylaxis guideline adherence are unclear at our institution. This is a retrospective, observational study of patients who received antibiotic prophylaxis between March 2011 and October 2020 at a level 1 trauma center. We sought to identify open fracture injury complications and assess adherence to institution antibiotic prophylaxis guidelines. Descriptive data and bivariate analyses are reported. Multivariable logistic regression was performed to identify independent risk factors associated with infectious complications. A total of 401 patients met study criteria; median age of 48 ± 20 years, 62% male. Fracture classifications were similar: 30% type I, 39% type II, and 30% type III. Infection occurred in 18.5% of patients, AKI in 20.3%, multi-drug resistant organism in 3%, and no patients developed C. difficile. Eighty-one percent received guideline adherent antibiotics. In bivariate analysis, fracture classification (P = 0.02) and antibiotic choice (P = 0.004) were associated with infection. Receiving a concomitant nephrotoxic medication was associated with AKI (P = 0.01). In logistic regression, only fracture classification was reliably and independently associated with occurrence of infection. Appropriate fracture classification and antibiotic choice is important to reduce infection following open fracture. Reducing concomitant exposure to nephrotoxic agents may reduce the risk of AKI.