A Comparison of Piperacillin-Tazobactam With Conventional Antibiotics for Prophylaxis in Lower Extremity Type III...

Background Prophylactic antibiotics for Gustilo-Anderson type III open fractures are cefazolin plus gentamicin (CG) at many institutions. Adverse effects such as nephrotoxicity make gentamicin a less appealing drug, particularly in trauma patients. The purpose of our study was to compare piperacillin-tazobactam (PT) with conventional antibiotics in preventing surgical site infections (SSIs) in lower extremity type III open fractures. Methods This was a single-center, retrospective analysis of 164 patients with lower extremity type III open fractures at the University of North Carolina at Chapel Hill, a large academic level one trauma center in Chapel Hill, North Carolina. They were treated with three different antibiotic regimens that comprised the cohort. Patients were separated into three groups: those receiving PT, CG, or cefazolin plus gentamicin plus injected tobramycin (CGT), depending on current protocols or the surgeon's discretion. Primary outcomes are deep (requiring return to OR) and superficial (requiring antibiotics only) SSIs, as well as nonunions, during a postoperative period of 12 months. Results Our retrospective analysis from 2008 to 2019 revealed 164 type III open fractures. Seventy-two fractures were treated with PT, 44 with CG, and 48 with CGT. There was not a statistically significant difference in deep or superficial infections among the three groups (p = 0.41, p = 0.52, respectively). Nonunion rates were also not significantly different. Conclusions The results of this study demonstrate no significant difference in SSIs or nonunion rate between PT, CG, and CGT when used for infection prophylaxis in type III open fractures. We believe prophylaxis with PT may be equivalent to traditional regimens, potentially with fewer adverse effects, particularly in polytraumatized patients.