Cefazolin Monotherapy Versus Cefazolin Plus Aminoglycosides for Antimicrobial Prophylaxis of Type III Open Fractures.

Abstract

BACKGROUND:

There are conflicting recommendations between organizations regarding aminoglycoside use for the prophylaxis of type III open fractures.

STUDY QUESTION:

To compare cefazolin monotherapy versus cefazolin plus aminoglycoside therapy for prophylaxis of type III open fractures in trauma patients.

STUDY DESIGN:

This was a multicenter, retrospective, cohort study conducted in 3 academic medical centers in the United States. Consecutive adult trauma patients with type III open fractures between January 2014 and September 2016 were included. Patients were divided into 2 groups: (1) cefazolin monotherapy versus (2) cefazolin plus aminoglycoside.

MEASURES AND OUTCOMES:

The primary outcome measure was the occurrence of infection at the open fracture site. The secondary outcome measure was the occurrence of acute kidney injury.

RESULTS:

There were 134 patients included in the study cohort. Of these, 39 received cefazolin monotherapy and 95 received cefazolin plus aminoglycoside. Overall, the mean age was 39 ± 15 years, 105 (78%) were male, and the most common fracture location was tibia/fibula (n = 74, 56%). Infection at the open fracture site occurred in 6 of 39 patients (15%) in the cefazolin monotherapy group and 15 of 95 patients (16%) in the cefazolin plus aminoglycoside group (P = 1.000). Acute kidney injury occurred in 0 of 39 (0%) in the cefazolin monotherapy group and 1 of 95 (1%) in the cefazolin plus aminoglycoside group (P = 1.000).

CONCLUSIONS:

Cefazolin monotherapy may be appropriate for antimicrobial prophylaxis of type III open fractures in trauma patients.

• Authors: Asad E Patanwala, John J Radosevich, Ian Meshay, Mandana Naderi, Mark A Culver, Yong G Lee, Jordan A Weinberg, Moteb Khobrani, David E Nix
• Journal: American journal of therapeutics (Am J Ther) Vol. 28 Issue 3 Pg. e284-e291 (Nov 25 2019) ISSN: 1536-3686 [Electronic] United States
• PMID: 31789627 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.