Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Trauma Care

Background:

• Deep surgical site infections (SSIs) are a significant complication following open tibia fractures.
• Gustilo-Anderson (GA) type III open tibia fractures represent severe injuries with a high risk of infection.
• The optimal timing for antibiotic administration in these fractures remains a critical question in trauma management.

Purpose of the Study:

• To investigate the association between the timing of emergency department (ED) antibiotic delivery and the incidence of deep SSIs.
• To evaluate the impact of early antibiotic administration on infection risk in patients with GA type III open tibia fractures.

Main Methods:

• Retrospective cohort study conducted at a Level I Trauma Center.
• Included patients aged ≥18 years with GA type III open tibia fractures (OTA/AO 41, 42, or 43) from 2016 to 2021.
• Analyzed deep SSI requiring irrigation and debridement, comparing antibiotic timing as a continuous variable and at 60- and 180-minute thresholds, adjusting for confounders like ISS and wound contamination.

Main Results:

• A total of 191 patients were analyzed, with a 90-day deep SSI risk of 10.5%.
• The median time to first antibiotic was 44 minutes.
• No significant association was found between antibiotic timing (continuous, <60 min, or <180 min) and the risk of deep SSI (aORs ranging from 1.00 to 1.08, P > 0.39).

Conclusions:

• Early antibiotic administration in the ED was not associated with a reduced risk of deep SSI in patients with GA type III open tibia fractures.
• The findings suggest that the acute timing of antibiotics may not be as critical as previously thought for preventing SSIs in this specific fracture type.
• Further research may be warranted to explore other factors influencing SSI development in severe open tibia fractures.