• J Orthop Trauma · Aug 2016

    Comparative Study

    Surgical Site Infections in Patients with Type III Open Fractures: Comparing Antibiotic Prophylaxis with Cefazolin plus Gentamicin versus Piperacillin/Tazobactam.

    • Jenessa Redfern, Scott M Wasilko, Meghan E Groth, Wesley D McMillian, and Craig S Bartlett.
    • *Department of Pharmacy, University of Vermont Medical Center, Burlington, VT; and †Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT.
    • J Orthop Trauma. 2016 Aug 1; 30 (8): 415-9.

    ObjectivesThe purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis.DesignRetrospective cohort study.SettingLevel 1 trauma center.PatientsSeven hundred sixty-six patients admitted between January 1, 2004, and December 31, 2012, with open fractures were identified using the National Trauma Data Bank by searching International Classification of Diseases, Ninth Revision (ICD-9) codes. Electronic medical record review revealed 134 patients with type 3 open fractures, of which 72 were included in the final analysis.InterventionAdministration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis.Main Outcome MeasurementsSSI, nonunion, death, and rehospitalization rates at 1 year.ResultsSurgical site infection at 1 year occurred in 12 of 37 patients (32.4%) in the cefazolin plus gentamicin group and 11 of 35 patients (31.4%) in the piperacillin/tazobactam group (P = 1.000). Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups. Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group (21.6% vs. 11.4%; P = 0.246).ConclusionsAt our institution, use of piperacillin/tazobactam as compared with cefazolin plus gentamicin for antibiotic prophylaxis in patients with type 3 open fractures showed similar rates of SSI, nonunion, mortality, and rehospitalization at 1 year after injury.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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