Limiting Antibiotics When Managing Mandible Fractures May Not Increase Infection Risk

To estimate and compare 1) the frequencies of surgical site infections (SSIs) and 2) adverse antibiotic effects (AAEs) between patients who receive only intraoperative antibiotics (study group) and those who receive intraoperative antibiotics plus additional preoperative or postoperative antibiotics (control group) while undergoing operative treatment of open mandibular fractures.

The authors designed a retrospective cohort study and enrolled a sample derived from patients presenting to the Harborview Medical Center from 2009 through 2014 for the management of open mandibular fractures. Eligible patients were at least 18 years of age with open, isolated mandibular fractures treated by open reduction and internal fixation using transoral approaches or closed reduction and intermaxillary fixation. The primary predictor variable was antibiotic exposure. The study group received antibiotics administered within 1 hour before the incision, with possible intraoperative re-dosing, and the control group received antibiotics according to the study group plus preoperative or postoperative antibiotics. The primary outcome was SSI frequency. The secondary outcome was AAE frequency. Univariate, bivariate, and multiple logistic regression analyses were performed. Statistical significance was set at a P value less than or equal to .05.

The sample was comprised of 510 patients (mean age, 29 ± 11.4 yr; 86% men). The study group had 58 patients (11%) and the control group had 452 patients (89%). The SSI frequencies in the study and control groups were 9 and 17%, respectively (P = .13). There were 5 (1%) AAEs reported, all in the control group. In the multivariable logistic regression model, only tobacco use was associated with an increased risk for SSI (odds ratio = 2.8; 95% confidence interval, 1.5-5.5; P = .0015).

Limiting antibiotic exposure to only intraoperative antibiotic prophylaxis in patients undergoing transoral operative treatment of isolated open mandibular fractures was not associated with an increased risk of SSIs.