Single Antibiotic Use with Ceftriaxone for Prophylaxis of All Open Fractures

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Trauma Care

Background:

• Open fractures require prompt antibiotic prophylaxis to prevent infection.
• Current protocols vary based on fracture severity (Gustilo type).
• Standardization of antibiotic prophylaxis may improve efficiency and outcomes.

Purpose of the Study:

• To compare the efficacy of a ceftriaxone (CTX) prophylactic antibiotic protocol for all open fractures against a traditional 'Classic' protocol.
• To evaluate deep and superficial infection rates, nonunion rates, and time to antibiotic administration.

Main Methods:

• Retrospective cohort study at a Level I trauma center.
• Included 521 adult patients with open fractures (December 2016 - December 2022).
• Compared outcomes between the CTX group (ceftriaxone for all) and the Classic group (cefazolin +/- gentamicin/ceftriaxone based on Gustilo type).

Main Results:

• No significant differences in deep infection (7.8% vs 12.7%), superficial infection (7.0% vs 4.7%), or nonunion (10.3% vs 7.9%) between CTX and Classic groups.
• CTX protocol demonstrated non-inferiority for deep infection rates across all Gustilo types.
• The CTX protocol was associated with a significantly shorter time to antibiotic administration (63.9 vs 114.1 minutes).

Conclusions:

• Prophylactic ceftriaxone for all open fractures is non-inferior to the classic protocol regarding deep infection rates.
• The CTX protocol leads to expedited antibiotic administration.
• Standardizing open fracture prophylaxis with ceftriaxone appears safe and effective for orthopedic trauma care.