Journal article
The Effect of Under-Dosing Prophylactic Antibiotics in the Care of Open Tibial Fractures
Journal of orthopaedic trauma, Vol.32(7), pp.322-326
07/01/2018
DOI: 10.1097/BOT.0000000000001171
PMID: 29634602
Abstract
Objectives: To determine the frequency and effect of under-dosing prophylactic weight-based antibiotics in patients with open tibial fractures. We hypothesized that patients who did not receive appropriate weight-based dosing of prophylactic antibiotics would have higher rates of infection.
Design: Retrospective cohort study.
Setting: Level 1 Trauma Center.
Patients/Participants: Patients 18 years of age or older with high-grade (Gustilo-Anderson type IIIA or IIIB) open extraarticular tibial fractures over a 5-year period.
Main Outcome: The primary outcome was deep infection within one year of initial injury. Appropriate weight-based dosing of cefazolin was defined as: at least 1 g for patients <80 kg, 2 g for patients between 80 and 120 kg, and 3 g for patients > 120 kg.
Results: Sixty-three patients met the inclusion criteria; 21 (33%) were under-dosed with cefazolin at the time of initial presentation. Among the 20 patients who subsequently developed deep infection, only 55% were appropriately dosed with cefazolin; of the patients who did not develop deep infection, 72% were appropriately dosed with cefazolin (P = 0.18). Univariate analysis revealed that hypertension was associated with infection (P = 0.049). Multivariable logistic regression analysis of infection due to all organisms did not reveal a statistically significant reduction in the odds of infection with appropriate weight-based dosing of cefazolin [Odds ratio = 0.42 (95% confidence interval, 0.12-1.48), P = 0.177]. Five of 7 (71%) of the gram positive, non-methicillin-resistant Staphylococcus aureus, infections occurred in patients who were under-dosed with cefazolin. Five (23.8%) of 21 patients who were under-dosed with cefazolin had gram-positive, non-methicillin-resistant S. aureus infections, compared to 2 (4.8%) of 42 patients who were appropriately dosed (P = 0.036).
Conclusions: Under-dosing of weight-based antibiotics in the treatment of open fractures is common. Appropriate weight-based dosing of cefazolin for prophylaxis in high-grade open tibial fractures reduces the frequency of infection due to cefazolin-sensitive organisms. Interestingly, organisms not susceptible to cefazolin were responsible for the majority of infections. The effect of under-dosing of cefazolin and other weight-based antibiotics deserves further investigation in larger studies.
Details
- Title: Subtitle
- The Effect of Under-Dosing Prophylactic Antibiotics in the Care of Open Tibial Fractures
- Creators
- Catherine R. Olinger - Campbell ClinicDavid Christopher Carver - Campbell ClinicVikki G. Nolan - University of MemphisJohn C. Weinlein - Campbell Clinic
- Resource Type
- Journal article
- Publication Details
- Journal of orthopaedic trauma, Vol.32(7), pp.322-326
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/BOT.0000000000001171
- PMID
- 29634602
- ISSN
- 0890-5339
- eISSN
- 1531-2291
- Number of pages
- 5
- Language
- English
- Date published
- 07/01/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984303963602771
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