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Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter
Rabiya K Mian1, Heather M Grossman Verner, Cynthia I Villalta
1From the Clinical Research Institute (R.K.M., H.M.G.V., C.I.V., D.F.), Methodist Health System; Department of Surgery (J.D.A.), Methodist Dallas Medical Center, Dallas, Texas; Department of Surgery (K.G.M.), Oregon Health & Science University, Portland, Oregon; Department of Surgery (R.K.), R. Adams Cowley Shock Trauma Center, Baltimore, Maryland; Department of Surgery (A.R.D.), St. Francis Hospital, Hartford, Connecticut; Department of Surgery (N.K.), University of Arizona College of Medicine, Phoenix, Arizona; Department of Surgery (E.E.M.), Ernest E Moore Shock Trauma Center at Denver Health, Denver, Colorado; Department of Surgery (C.A.), University California Irvine, Orange, California; Department of Surgery (J.M.), University of Texas Health Tyler, Tyler; Department of Surgery (T.C.P.C.), Dell Seton Medical Center, Austin, Texas; Department of Surgery (R.H.L.), Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana; Department of Surgery (J.A.Z.), George Washington University, Washington, District of Columbia; Department of Surgery (C.M.B.), UCHealth Medical Center of the Rockies, Loveland, Colorado; Department of Trauma (G.T.), Scripps Memorial Hospital La Jolla, La Jolla, California; Department of Surgery (M.C.), Ascension St. John Medical Center, Tulsa, Oklahoma; Department of Surgery (M.W.C.), University of Colorado, Denver, Colorado; Department of Surgery (L.A.D.), University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery (J.B.), Erlanger, Chattanooga, Tennessee; Department of Surgery (T.E.), Cooper University Hospital, Camden, New Jersey; and Department of Surgery (J.H.R.), University of North Carolina, Chapel Hill, North Carolina.
Background:
Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures.
Methods:
A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H , Mann-Whitney U , Pearson's χ 2 , Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications.
Results:
Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications ( p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668).
Conclusion:
Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures.
Level Of Evidence:
Therapeutic/Care Management; Level II.
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