Related Experiment Video
Updated: Jun 18, 2025
A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials
Published on: March 3, 2023
Antibiotics Within One Hour for Pediatric Open Lower Extremity Fractures May Not be Warranted as a Quality Metric
Marlene Jacobo1, Areg Grigorian1, Lourdes Swentek1
1Division of Trauma, Burns & Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA.
Insights
Early antibiotics for pediatric open fractures did not reduce infection risk. Surgical site infection rates were similar whether antibiotics were given within or after one hour, suggesting a need to re-evaluate this quality metric.
Area of Science:
- Pediatric Trauma Surgery
- Orthopedic Surgery
- Infectious Disease Prevention
Background:
- Adult open fractures require timely antibiotics to prevent infection.
- Antibiotic timing is a quality metric for adult trauma centers.
- Limited data exists on antibiotic timing for pediatric open fractures.
Purpose of the Study:
- To evaluate the association between early antibiotic administration and surgical site infection (SSI) risk in pediatric open lower extremity fractures.
- To determine if the 1-hour antibiotic administration guideline is appropriate for pediatric trauma patients.
Main Methods:
- Retrospective analysis of the 2019 Trauma Quality Improvement Program dataset.
- Included pediatric patients (≤16 years) with isolated open femur or tibia fractures.
- Compared SSI rates between early (≤1h) and delayed (>1h) antibiotic groups using multivariate logistic regression.
Main Results:
- 150 pediatric patients with open lower extremity fractures were analyzed.
- No significant difference in SSI rates between early (1.0%) and delayed (1.9%) antibiotic groups (P=0.65).
- Adjusted analysis confirmed no increased infection risk with delayed antibiotics.
Conclusions:
- Most pediatric patients received antibiotics within 1 hour for open lower extremity fractures.
- SSI is rare in this population, and timing of antibiotics showed no significant impact on infection risk.
- The 1-hour antibiotic administration window should be reconsidered as a quality metric for pediatric open lower extremity fractures.
Background:
Open fractures have been associated with a higher risk of infection if antibiotics are not administered within 1 h of presentation in adult trauma patients. Time to antibiotic administration for open fractures is frequently used as a quality metric for trauma centers, but there have been no large studies evaluating this topic for pediatric patients.
Methods:
The 2019 Trauma Quality Improvement Program dataset was queried for patients ≤ 16 years old with isolated open femur or tibia fractures undergoing operative intervention after blunt trauma. Patients transferred from another hospital were excluded. Pediatric patients receiving early antibiotics (EA) within 1 h were compared to patients receiving delayed antibiotics (DA) greater than or equal to 1 h from arrival. Multivariate logistic regression was used to evaluate risk of surgical site infection (SSI).
Results:
There were 150 patients with open lower extremity fractures: 98 (64.9%) EA vs 52 (34.4%) DA. There was no difference in the rate of SSI between the 2 groups (EA: 1.0% vs DA: 1.9%, P = 0.65). There remained similar associated risk of infection after adjusting for lower extremity abbreviated injury scale >3, blood transfusion requirement, and vital signs on arrival (OR 0.62, 95% CI 0.04-10.24, P = 0.74).
Conclusions:
Most pediatric trauma patients with open lower extremity fracture received antibiotics within 1 h of presentation. However, SSI was rare and the risk of SSI was not associated with antibiotic administration within 1 h. Therefore, timing of antibiotic administration for pediatric open lower extremity fractures should be re-evaluated as a quality metric.Level of Evidence: Level III.
More Related Videos
11:17Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
09:17A Robust Pneumonia Model in Immunocompetent Rodents to Evaluate Antibacterial Efficacy against S. pneumoniae, H. influenzae, K. pneumoniae, P. aeruginosa or A. baumannii
Published on: January 2, 2017
