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Tucker J, Oxford M, Ziai K, Lighthall JG. Utility of Antibiotic Use in Pediatric Facial Fractures: A Systematic Review. Facial Plast Surg Aesthet Med 2024. [PMID: 38656206 DOI: 10.1089/fpsam.2023.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: In regard to antibiotic stewardship, it is important to understand the appropriate time to prescribe antibiotics in pediatric facial fracture management. Objective: To evaluate the utility of antibiotics in pediatric facial fractures and determine situational variables influencing appropriate antibiotic prescription. Methods: A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2000 to 2022. Inclusion criteria consisted of all studies assessing pediatric facial fractures that mentioned antibiotic use. Results: A total of 13 studies were included in the full review. The reviewed studies comprised 31 pediatric patients ranging from 6 months to 18 years old. Most studies were case reports and case series (N = 9). Antibiotics were prescribed for the majority (96.7%) of patients. Antibiotic regimens varied by timing of administration, antibiotic used, and dosage. Fracture locations also varied widely, including orbital, zygomatic, nasal, mandibular, and maxillary fractures. Conclusions: Additional studies with more substantial evidence are needed to fully understand the situational appropriateness of antibiotic use in pediatric facial fractures.
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Affiliation(s)
- Jacqueline Tucker
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Madison Oxford
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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2
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Rikhotso RE, Mohotlhoane GP. The Effect of Duration of Antibiotic Prophylaxis on Infections Following Open Reduction and Internal Fixation of Mandibular Fractures: A Prospective Randomized Clinical Trial. J Craniofac Surg 2024; 35:185-188. [PMID: 37870535 DOI: 10.1097/scs.0000000000009784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023] Open
Abstract
AIM To evaluate the benefits of a long-term prophylactic antibiotic regimen following treatment of fractured mandibles with open reduction and internal fixation. MATERIAL AND METHODS A prospective, randomized controlled trial was undertaken at Wits Oral Health Centre. Patients with mandibular fractures who were managed with open reduction and internal fixation using miniplates were randomized into 2 groups. The control group, the perioperative antibiotic (POA) group, was composed of patients who received intravenous (IV) antibiotic cover intraoperatively and a further 3 IV doses 24 hours postoperatively. The study group, the extended postoperative antibiotic (EPOA), was composed of patients who received similar doses as the control group but with an additional 5 days of oral antibiotics upon discharge. The patients were then evaluated for evidence of infection 1, 4, and 6 weeks postoperatively. RESULTS A total of 77 patients were included in the study, 41 in the POA and 36 in the EPOA groups. Fourteen patients had evidence of infection noted within the 6-week follow-up period (10 in the POA and 4 in the EPOA groups). Statistical analysis with the Pearson Chi-square and Student t test showed no statistically significant difference ( P =0.399) between POA and EPOA groups. There were no significant differences between the groups with respect to site and etiology of fracture, duration of operation, and presence of infection ( P >0.05) during the 6-week review period. CONCLUSIONS The extended use of antibiotic prophylaxis when managing mandibular fractures with open reduction and internal fixation offers no additional benefit in reducing postoperative infections.
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Affiliation(s)
- Risimati E Rikhotso
- Department of Maxillofacial and Oral Surgery, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jani A, Chaudhry K, Kaur A, Bhatia PK, Kumar P, Gigi PG, Batra T, Chugh A. Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101576. [PMID: 37544506 DOI: 10.1016/j.jormas.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Enhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. METHODOLOGY A randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. RESULTS Baseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). CONCLUSION Our study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.
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Affiliation(s)
- Astha Jani
- All India Institute of Medical Sciences, Jodhpur, India
| | | | - Amanjot Kaur
- All India Institute of Medical Sciences, Vijaypur, Jammu, India
| | | | - Pravin Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | - P G Gigi
- All India Institute of Medical Sciences, Jodhpur, India
| | - Tanya Batra
- All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- All India Institute of Medical Sciences, Jodhpur, India.
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Gibson AC, Merrill TB, Boyette JR. Complications of Mandibular Fracture Repair. Otolaryngol Clin North Am 2023; 56:1137-1150. [PMID: 37353369 DOI: 10.1016/j.otc.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.
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Affiliation(s)
- Anna Celeste Gibson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA.
| | - Tyler Branch Merrill
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
| | - Jennings Russell Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
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Harryman C, Park S, Oyer S. Should Systemic Antibiotics be Used Regularly for Mandible Fractures? Laryngoscope 2023; 133:3233-3234. [PMID: 37309842 DOI: 10.1002/lary.30810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/17/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Christopher Harryman
- Department of Otolaryngology, University of Virginia Medical Center, Charlottesville, Virginia, U.S.A
| | - Stephen Park
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, University of Virginia Medical Center, Charlottesville, Virginia, U.S.A
| | - Samuel Oyer
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology, University of Virginia Medical Center, Charlottesville, Virginia, U.S.A
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Kent S, Adatia A, James P, Bains K, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P. Risk factors associated with short-term complications in mandibular fractures: the MANTRA study-a Maxillofacial Trainee Research Collaborative (MTReC). Oral Maxillofac Surg 2023; 27:609-616. [PMID: 35788932 PMCID: PMC10684408 DOI: 10.1007/s10006-022-01096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. METHODS The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. RESULTS Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. DISCUSSION We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.
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Affiliation(s)
- S Kent
- University Hospital of Wales, Cardiff, UK.
| | - A Adatia
- Aintree University Hospital, Liverpool, UK
| | - P James
- Aintree University Hospital, Liverpool, UK
| | - K Bains
- Aintree University Hospital, Liverpool, UK
| | - A Henry
- Swansea Bay University Health Board, Swansea, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - B Dawoud
- North Manchester General Hospital, Manchester , UK
| | - D Kumar
- Liverpool Medical School, Liverpool, UK
| | - C Jefferies
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Kyzas
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Gaessler J, Morocutti D, Merkl M, Remschmidt B, Zemann W, Schwaiger M. Surgical site infections in maxillofacial trauma surgery - Single-dose versus prolonged antibiotic prophylaxis. J Craniomaxillofac Surg 2023; 51:649-654. [PMID: 37709626 DOI: 10.1016/j.jcms.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Open reduction with internal fixation (ORIF) for facial fractures has frequently been associated with the occurrence of surgical site infections (SSIs). Perioperative antibiotic prophylaxis is customarily recommended for ORIF. Thus, the comparison of two different antibiotic regimens (i.e., single-dose and prolonged antibiotic prophylaxis) concerning the rate and severity of SSIs in facial fracture patients undergoing ORIF was the main purpose of this study. This retrospective analysis included patients who underwent ORIF for facial fractures. They were distributed into two groups. The single-dose antibiotic prophylaxis group (SDAP) received single-dose perioperative antibiotic prophylaxis, whereas the prolonged antibiotic prophylaxis group (PAP) were administered prophylactic antibiosis over a course of 5 days. 122 patients were included in the study. Nine patients in the SDAP group and 15 patients in the PAP group were affected by SSIs; no significant difference in the incidence of SSIs was found (p = 0.218). Moreover, the severity of SSIs did not significantly differ between the two groups (p = 0.982).
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Affiliation(s)
- Jan Gaessler
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Auenbruggerplatz 5, 8010, Graz, Austria.
| | - Dominic Morocutti
- Division of Restorative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, 8010, Graz, Austria.
| | - Markus Merkl
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Auenbruggerplatz 5, 8010, Graz, Austria.
| | - Bernhard Remschmidt
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Auenbruggerplatz 5, 8010, Graz, Austria.
| | - Wolfgang Zemann
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Auenbruggerplatz 5, 8010, Graz, Austria.
| | - Michael Schwaiger
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, Auenbruggerplatz 5, 8010, Graz, Austria.
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Tucker J, Goldenberg D, Brandon C, King TS, Ziai K, Lighthall JG. Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures. J Oral Maxillofac Surg 2023; 81:869-877. [PMID: 37116541 PMCID: PMC10790685 DOI: 10.1016/j.joms.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. PURPOSE This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. STUDY DESIGN, SETTING, SAMPLE In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18 years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing of antibiotic administration, categorized by pre, intra, and postoperative administration. MAIN OUTCOME VARIABLES Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. COVARIATES Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. ANALYSES χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P < .05. RESULTS This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P = .12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P = .79). There was a significant association between the timing of antibiotic use and infection (P = .044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P = .023). CONCLUSION AND RELEVANCE While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.
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Affiliation(s)
- Jacqueline Tucker
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Dana Goldenberg
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Cameron Brandon
- Resident, Department of Neurosurgery, The Ohio State University, Columbus, OH
| | - Tonya S King
- Statistician, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Kasra Ziai
- Chief Resident, Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Jessyka G Lighthall
- Associate Professor, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
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Barrett T, Chi J. Evidence-Based Medicine for Mandible Fracture Repair: Current Controversies and Future Opportunities. Facial Plast Surg 2023; 39:214-219. [PMID: 36603829 DOI: 10.1055/a-2008-2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Mandibular fractures are among the most common facial fractures resulting from trauma. The nature of the injury, involved facial structures, presence of associated injuries, the dental status of the patient, comorbid conditions, and psychosocial context all must be considered by the surgeon when planning the optimal treatment for these patients. While consensus exists for many aspects of the management of mandibular trauma, some elements remain controversial. Three such topics-antibiotic therapy, treatment of subcondylar fractures, and management of the third molar-remain particularly controversial, with significant heterogeneity in practice patterns and without widely accepted evidence-based guidelines to standardize care. The goals of this work are to (1) review the historical perspective underlying these controversies, (2) summarize recent evidence shaping the current debate, and (3) highlight opportunities for continued efforts to identify best practices.
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Affiliation(s)
- Thomas Barrett
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - John Chi
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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Non- surgical management of non- condylar mandible fractures. Br J Oral Maxillofac Surg 2022; 60:1224-1227. [DOI: 10.1016/j.bjoms.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022]
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Systemic Antibiotic Prophylaxis in Maxillofacial Trauma: A Scoping Review and Critical Appraisal. Antibiotics (Basel) 2022; 11:antibiotics11040483. [PMID: 35453234 PMCID: PMC9027173 DOI: 10.3390/antibiotics11040483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/27/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. Therefore, the purpose of this scoping review was to provide an overview of the current evidence that supports the use of prophylactic antibiotics in the treatment of maxillofacial fractures. A comprehensive literature search on 1 January 2022, in PubMed, Web of Science, Embase, and Cochrane, revealed 16 articles. Most studies focused on the duration of systemic antibiotic prophylaxis and compared a one-day to a five-day regimen. Included studies showed considerable variability in design and research aims, which rendered them difficult to compare. Furthermore, a variety of antibiotic regimens were used, and most studies had a short follow-up period and unclear outcome parameters. This scoping review demonstrates the lack of well-constructed studies investigating the type and duration of systemic antibiotic prophylaxis in the treatment of maxillofacial trauma. Based on the included articles, prolonging antibiotic prophylaxis over 24 h for surgically treated fractures does not appear to be beneficial. Furthermore, there is no evidence for its use in conservatively treated fractures. These results should be interpreted with caution since all included studies had limitations.
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Cicuttin E, Sartelli M, Scozzafava E, Tartaglia D, Cremonini C, Brevi B, Ramacciotti N, Musetti S, Strambi S, Podda M, Catena F, Chiarugi M, Coccolini F. Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence. Antibiotics (Basel) 2022; 11:antibiotics11020139. [PMID: 35203743 PMCID: PMC8868174 DOI: 10.3390/antibiotics11020139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.
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Affiliation(s)
- Enrico Cicuttin
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | | | - Emanuele Scozzafava
- Unit of Maxillo-Facial Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.S.); (B.B.)
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Camilla Cremonini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Bruno Brevi
- Unit of Maxillo-Facial Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.S.); (B.B.)
| | - Niccolò Ramacciotti
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Serena Musetti
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Silvia Strambi
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, 09123 Cagliari, Italy;
| | - Fausto Catena
- General and Emergency Surgery Department, Bufalini Hospital, 47521 Cesena, Italy;
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56100 Pisa, Italy; (E.C.); (D.T.); (C.C.); (N.R.); (S.M.); (S.S.); (M.C.)
- Correspondence:
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Kumar D, Dawoud BES, Kent S, MTReC, Kyzas P. Antibiotic practices in non-condylar mandibular fractures: a Maxillofacial Trainee Research Collaborative (MTReC) UK-wide survey. Br J Oral Maxillofac Surg 2021; 60:291-294. [PMID: 34838340 DOI: 10.1016/j.bjoms.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
Non-condylar mandibular fractures are consdered 'open' fractures and as such are thought to require prophylactic antibiotics. There is no overall consensus on the optimal regimen or choice of antibiotic in the preoperative and postoperative periods due to a lack of high-quality evidence. We therefore set out to ascertain the current UK-wide practice of antibiotic prescribing for non-condylar mandibular fractures. We used a web-based online survey (Google Forms) that was disseminated via email and social media platforms to oral and maxillofacial surgery (OMFS) consultants and trainees of all grades. The questions focused on usual antibiotic practices and typical clinical management of non-condylar mandibular fractures. We gathered information on preoperative antibiotics, and on perioperative and postoperative periods. We collected data from 50 different UK OMFS units representing a broad snapshot of national practice. The majority of responders were speciality trainees (36%) followed by dental core trainees (34%). A total of 45/50 centres routinely admitted patients, and preoperative intravenous antibiotics were commenced on admission by 77/89 respondents, intravenous being the chosen route in all cases. In the preoperative period 81% prescribe co-amoxiclav. In 91% of cases, open reduction and internal fixation (ORIF) was on general emergency (CEPOD) operating lists, whilst dedicated OMFS trauma lists accounted for 9%. With respect to timing, 49% aimed to carry out ORIF within 24 hours from the time of admission, 44% aimed for surgery within 24 - 48 hours, and 6% aimed for surgery on a semielective basis (48 hours or more). Postoperative antibiotics were prescribed routinely by 88% of responders. Preoperative intravenous prophylactic antibiotics are commonplace in non-condylar mandibular fractures. This UK-wide survey demonstrated significant variability in antibiotic prescribing practices, especially in the postoperative period. Most units still rely on CEPOD emergency theatres to provide the capacity for ORIF in this patient group.
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Affiliation(s)
| | - B E S Dawoud
- Department of Oral & Maxillofacial Surgery, North Manchester General Hospital, Manchester University NHS Foundation Trust.
| | - S Kent
- Department of Oral and Maxillofacial Surgery.
| | - MTReC
- Maxillofacial Trainee Research Collaborative
| | - P Kyzas
- Department of Oral and Maxillofacial Surgery, Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust.
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