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Appelbaum RD, Farrell MS, Gelbard RB, Hoth JJ, Jawa RS, Kirsch JM, Mandell S, Nohra EA, Rinderknecht T, Rowell S, Cuschieri J, Stein DM. Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001304. [PMID: 38835634 PMCID: PMC11149135 DOI: 10.1136/tsaco-2023-001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Affiliation(s)
- Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Farrell
- Department of Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Jason Hoth
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Randeep S Jawa
- Department of Surgery, Stony Brook University, Stony Brook, New York, USA
| | - Jordan M Kirsch
- Department of Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Samuel Mandell
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eden A Nohra
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | | | - Susan Rowell
- Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Joseph Cuschieri
- Department of Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
| | - Deborah M Stein
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland, 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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Oksa M, Haapanen A, Marttila E, Furuholm J, Snäll J. Postoperative wound dehiscence in mandibular fractures. Acta Odontol Scand 2023; 81:555-561. [PMID: 37171859 DOI: 10.1080/00016357.2023.2211156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To clarify the occurrence and causes of non-infection-related surgical wound dehiscence (SWD) in intraorally treated mandibular fractures. MATERIAL AND METHODS Patients with one or two fractures of the dentate part of the mandible treated surgically via an intraoral approach were included in this retrospective study. The primary outcome variable was SWD. Associations between patient-, fracture- and surgery-related variables and SWD were evaluated. RESULTS Altogether 232 patients with 270 mandibular angle, body, symphysis and/or parasymphysis fractures were included in the analysis. In all, 22 SWDs were detected. These occurred in 9.5% of patients and in 8.1% of fractures. Surgery performed at night-time showed a significantly higher SWD rate than daytime surgeries (p = .012). Additionally, a significantly greater SWD rate was found among smokers (p = .041). Other studied variables remained statistically non-significant for SWD. In a multivariate analysis, night-time was the only significant independent variable with an odds ratio of 3.297 (95% CI 1.238 - 8.780, p = .017) for SWD. CONCLUSION The approach or closure technique used and the fracture type had only a minor effect on non-infection-related SWD in patients with mandibular fractures. To avoid SWDs, mandibular fracture surgeries should be conducted during the daytime with adequate support from an experienced surgeon.
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Affiliation(s)
- Marko Oksa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Emilia Marttila
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
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Mohanty R, Awasthi N, Hosmani SB, Sankaranarayanan AI, Oberoi NH, Singh PK, Singh N, Patel D. Comparing the Efficacy of Postoperative Antibiotic Regimens in the Treatment of Maxillofacial Fractures: A Prospective Study. J Contemp Dent Pract 2023; 24:454-458. [PMID: 37622622 DOI: 10.5005/jp-journals-10024-3493] [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: 08/26/2023]
Abstract
AIM The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. MATERIALS AND METHODS About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. RESULTS No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. CONCLUSION A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. CLINICAL SIGNIFICANCE In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.
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Affiliation(s)
- Rajat Mohanty
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Naman Awasthi
- Department of Dentistry, Government Medical College, Shahdol, Madhya Pradesh, India
| | - Shrinivas Baburao Hosmani
- Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India, Phone: +91 9986283409, e-mail:
| | - Anju Innaran Sankaranarayanan
- Department of Oral and Maxillofacial Surgery, Century International Institute of Dental Science and Research Center, Kasaragod, Kerala, India
| | - Nimish H Oberoi
- Private Practice Consultant, The Smile Project Dental Clinic, Chembur, Mumbai, India
| | - Praveen Kumar Singh
- Department of Oral and Maxillofacial Surgery, Chandra Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Nikhil Singh
- Consultant Oral Surgeon, P. V. Doshi Hospital, Mumbai, India
| | - Dharati Patel
- Department of Pediatric and Preventive Dentistry, Narsinhbhai Patel Dental College & Hospital, Sankalchand Patel University, Visnagar, Gujarat, India
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Atwez A, Antosz K, Cooper L, Le P, Mujadzic T, Seagle J, Mujadzic M, Friedman H. Preoperative Prophylactic Antibiotics in Mandibular Fractures and Surgical Site Infection. Ann Plast Surg 2023; 90:S326-S331. [PMID: 37332207 DOI: 10.1097/sap.0000000000003453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Compared with other facial fractures, mandibular fractures have the highest rate of postsurgical site infection. There is strong evidence to suggest that postoperative antibiotics do not reduce rates of surgical site infections (SSIs) regardless of duration. However, there are conflicting data in the literature regarding the role of prophylactic preoperative antibiotics in reducing rates of SSIs. This study reviews the rate of infections in patients who underwent mandibular fracture repair who received a course of preoperative prophylactic antibiotics compared with those who received no or 1 dose of perioperative antibiotics. METHODS Adult patients who underwent mandibular fracture repair at Prisma Health Richland between 2014 and 2019 were included in the study. A retrospective cohort review was conducted to determine the rate of SSI, comparing 2 groups of patients who underwent mandibular fracture repair. Patients who received more than 1 dose of scheduled antibiotics before surgery were compared with those who did not receive any antibiotic treatment before surgery or received only a single dose of antibiotics within 1 hour of incision time (perioperative antibiotics). The primary outcome was the rate of SSI between the 2 groups of patients. RESULTS There were 183 patients who received more than 1 dose of scheduled antibiotics before surgery and 35 patients who received a single dose of perioperative antibiotics or did not receive any antibiotics. The rate of SSI was not significantly different in the preoperative prophylactic antibiotics group (29.3%) compared with the patients who received a single perioperative dose or no antibiotics (25.0%). CONCLUSION Extended regimens of preoperative prophylactic antibiotics beyond a single dose at time of surgery do not reduce SSIs after surgical repair in mandibular fractures.
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Affiliation(s)
- Abdelaziz Atwez
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | | | | | - Paulina Le
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | - Tarik Mujadzic
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | | | - Mirsad Mujadzic
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
| | - Harold Friedman
- From the Division of Plastic Surgery, University of South Carolina School of Medicine/Prisma Health
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Beckstrom TO, Dodson TB, Lang MS. Measuring Adherence to Antibiotic Use Guidelines in Managing Mandible Fractures. J Oral Maxillofac Surg 2023; 81:287-291. [PMID: 36581312 DOI: 10.1016/j.joms.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/29/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Due to variability in practice patterns when managing patients with facial fractures, the Surgical Infection Society's Therapeutics and Guidelines Committee (SIS) released guidelines in June 2020 concerning antibiotic use in the treatment of patients with facial fractures. The purpose of this study was to measure adherence to SIS guidelines among patients treated for isolated mandibular fractures and to identify factors associated with deviation from SIS guidelines. MATERIALS AND METHODS The authors designed and implemented a retrospective cohort study and enrolled a sample derived from the population of patients treated for isolated mandibular fractures at Harborview Medical Center (Seattle, WA) and University of Washington Medical Center-Montlake (Seattle, WA) from June 2020 through October 2021. The primary outcome variable was adherence to SIS antibiotic guidelines (yes or no). Covariates were grouped into the following categories: demographic (age, gender), treatment (operative treatment, primary service, transfer status), and risk factor (Charlson Comorbidity Index, tobacco use, alcohol use, drug use other than marijuana, mandibular injury severity score). Descriptive and bivariate statistics were computed to measure the association between adherence and the study variables. The level of statistical significance was set at a P-value ≤.05. RESULTS The study sample was composed of 114 patients with a mean age of 41.8 ± 19.0 years and 72% were males. The frequency of adherence to SIS antibiotic protocol was 91.2%. Variables associated with deviation from SIS antibiotic protocol were operative treatment (P-value = .03 - relative risk (RR) not calculable), current drug use other than marijuana (RR = 4.1; 95% confidence interval, 1.3-12.8; P-value = .01), and transfer from an outside facility (RR = 4.1; 95% confidence interval, 1.3-12.8; P-value = .01). CONCLUSIONS The findings of this study suggest that the SIS antibiotic guidelines in the management of isolated mandible fractures were translated well into practice at our institution as evidenced by the high level of compliance (>90%). To improve adherence, additional research is indicated to better understand how factors such as treatment choice, drug exposure, and transfer status adversely affect adherence to guidelines.
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Affiliation(s)
- Thomas O Beckstrom
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
| | - Thomas B Dodson
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Melanie S Lang
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
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Gaal A, Shimchuk A, Gray S, Bloomquist D, Dillon J. Are postoperative antibiotics required after orthognathic surgery? Int J Oral Maxillofac Surg 2023; 52:211-218. [PMID: 35780069 DOI: 10.1016/j.ijom.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate and compare the frequency of surgical site infection (SSI) between orthognathic patients who received only intraoperative antibiotics and patients who received intraoperative antibiotics plus postoperative antibiotics. A retrospective study was performed of patients treated by a single surgeon over the years 2006-2012 and 2016-2019. The primary predictor variable was antibiotic exposure. The control group received no postoperative prophylactic antibiotics. The study group received postoperative antibiotics. Both groups received prophylactic intraoperative antibiotics and performed postoperative chlorhexidine rinses. The primary outcome was SSI frequency. Univariate, bivariate, and multiple logistic regression analyses were performed; statistical significance was set at P ≤ 0.05. The sample comprised 333 patients. Their mean age was 30.7 ± 11.8 years. The study group included 129 patients (38.7%); the control group included 204 patients (61.3%). The frequency of SSI was 17.1% in the study group and 26.5% in the control group (P = 0.048). In the multivariable logistic regression, only alcohol consumption was significantly associated with an increased risk of SSI (odds ratio 2.46, 95% confidence interval 1.36-4.44; P = 0.003). In patients undergoing orthognathic surgery, postoperative antibiotic exposure in addition to intraoperative prophylaxis approached but was not statistically significant for a decreased risk of SSI (P = 0.067).
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Affiliation(s)
- A Gaal
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
| | - A Shimchuk
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
| | - S Gray
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
| | - D Bloomquist
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
| | - J Dillon
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA, USA.
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Duane TM, Sercy E, Banton KL, Blackwood B, Hamilton D, Hentzen A, Hatch M, Akinola K, Gordon J, Bar-Or D. Factors associated with delays in medical and surgical open facial fracture management. Trauma Surg Acute Care Open 2022; 7:e000952. [PMID: 36068845 PMCID: PMC9437730 DOI: 10.1136/tsaco-2022-000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Open fractures are at risk of infection because of exposure of bone and tissue to the environment. Facial fractures are often accompanied by other severe injuries, and therefore fracture management may be delayed until after stabilization. Previous studies in this area have examined timing of multiple facets of care but have tended to report on each in isolation (eg, antibiotic initiation). Methods This was a retrospective study of adult patients admitted to five trauma centers from January 1, 2017 to March 31, 2021 with open facial fractures. Variables collected included demographics, injury mechanism, details on facial and non-facial injuries, facial fracture management (irrigation and debridement (I&D), irrigation without debridement, open reduction internal fixation (ORIF), antibiotics), and other hospital events. The study hypothesized that the presence of serious non-facial injuries would be associated with delays in facial fracture management. The primary aims were to describe open facial fracture management practices and examine factors associated with early versus delayed fracture management. A secondary aim was to describe infection rates. Early treatment was defined as within 24 hours of arrival for I&D, irrigation without debridement, and ORIF and within 1 hour for antibiotics. Results A total of 256 patients were included. Twenty-seven percent had major trauma (Injury Severity Score ≥16). The presence of serious head injury/traumatic brain injury was associated with delayed I&D (ORearly=0.04, p<0.01), irrigation without debridement (ORearly=0.09, p<0.01), and ORIF (ORearly=0.10, p<0.01). Going to the OR within 24 hours was associated with early I&D (ORearly=377.26, p<0.01), irrigation without debridement (ORearly=13.54, p<0.01), and ORIF (ORearly=154.92, p<0.01). The infection rate was 4%. Conclusions In this examination of multiple aspects of open facial fracture management, serious injuries to non-facial regions led to delays in surgical fracture management, consistent with the study hypothesis. Level of evidence Level III, prognostic/epidemiological.
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Affiliation(s)
- Therese M Duane
- Trauma Services Department, Medical Center of Plano, Plano, Texas, USA
| | - Erica Sercy
- Trauma Research Department, Injury Outcomes Network, Englewood, Colorado, USA
| | - Kaysie L Banton
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Brian Blackwood
- Department of Orthopedic Surgery, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
| | - David Hamilton
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Andrew Hentzen
- Trauma Services Department, Wesley Medical Center, Wichita, Kansas, USA
| | - Matthew Hatch
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Kerrick Akinola
- Trauma Services Department, St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
| | - Jeffrey Gordon
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - David Bar-Or
- Trauma Research Department, Injury Outcomes Network, Englewood, Colorado, USA
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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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Oksa M, Haapanen A, Marttila E, Snäll J. Simple dentate area fractures of the mandible - can we prevent postoperative infections? Acta Odontol Scand 2022; 80:494-500. [PMID: 35130467 DOI: 10.1080/00016357.2022.2036812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate the occurrence of surgical site infections and predisposing factors for these in simple mandibular fractures. MATERIAL AND METHODS A retrospective study of patients with fractures of the dentate part of the mandible included patients with intraorally treated simple fractures of the mandibular body, symphysis, and parasymphysis. The primary outcome variable was postoperative surgical site infection. Use of antibiotics, injury mechanism, fracture and surgery-related explanatory variables, patient-related variables and level of oral hygiene according to the modified Total Dental Index were evaluated. RESULTS Of 254 patients with mandibular fractures, 107 were included in the final analysis. The infection group consisted of 18 patients (16.8%). Despite the high infection occurrence, significant differences were not found between antibiotic use or other studied variables and infection occurrence. Infections occurred mainly in patients without any specific explanatory factor for infection. CONCLUSION The notably high occurrence of surgical site infections despite antibiotic use after simple mandibular fracture surgery highlights the importance of perioperative tissue handling and local oral circumstances. It is also necessary to consider whether we generally accept the high risk of infection associated with the intraorally treated simple mandibular fractures.
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Affiliation(s)
- Marko Oksa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Emilia Marttila
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
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Michel JC, Amin D, Gelbard RB, Abramowicz S. An evidence-based approach to antibiotic use in maxillofacial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:151-158. [PMID: 35428598 DOI: 10.1016/j.oooo.2021.12.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/13/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
A patient with craniomaxillofacial (CMF) trauma often receives consultations from multiple medical and surgical services. Antibiotics are sometimes prescribed without consistent evidence. This article reviews current literature regarding antibiotic prophylaxis of patients with CMF fractures. This article also presents the guidelines for the appropriate use of antibiotics for patients with CMF fractures at 2 level I trauma centers.
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Affiliation(s)
- Jonathan C Michel
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA; Associate Professor of Surgery, Acute Care Surgery, Medical Director of Trauma Burn Intensive Care Unit, Chief of Critical Care Services, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Dina Amin
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shelly Abramowicz
- Previously, Resident-in-Training, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA; Facial Cosmetic Surgery Fellow, Louisiana State University Health Science Center New Orleans, Department of Oral and Maxillofacial Surgery, Williamson Cosmetic Center and Perenack Aesthetic Surgery, Baton Rouge, LA; Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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13
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Murakami K, Yamamura K, Minemura C, Takayama T, Kimura Y, Yokoe H. Limiting antibiotic prophylaxis in the treatment of maxillofacial fractures: A retrospective, single-center study of 81 patients. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Erstad BL, Kopp BJ, Tang AL. Antibiotic prophylaxis for traumatic facial fractures. J Clin Pharm Ther 2021; 47:386-395. [PMID: 34490647 DOI: 10.1111/jcpt.13530] [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: 06/29/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/25/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The purpose of this paper is to discuss the limitations of the evidence supporting the SIS recommendations for antibiotic prescribing in patients with traumatic facial fractures and to provide suggestions for clinical decision-making and further research in this area given the wide variation in prescribing practices. COMMENT The Surgical Infection Society (SIS) recently published guidelines on antibiotic use in patients with traumatic facial fractures. The guidelines recommend against the use of prophylactic antibiotics for all adult patients with mandibular or non-mandibular facial fractures undergoing non-operative or operative procedures. Despite the available evidence, surveys conducted in the United States and the United Kingdom prior to the publication of the SIS guidelines demonstrate substantial preoperative, intraoperative and postoperative prophylactic prescribing of antibiotics for patients with facial fractures undergoing surgery. WHAT IS NEW AND CONCLUSION With the exception of strong recommendations based on moderate-quality evidence to avoid prolonged postoperative antibiotic prophylaxis, the weak recommendations in the guidelines are a function of low-quality evidence. A logical choice for a narrow-spectrum antibiotic is cefazolin administered within 1 h of surgery and no longer than 24 h after surgery, since it is the gold standard of comparison based on clinical practice guidelines concerning antibiotic prophylaxis.
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Affiliation(s)
- Brian L Erstad
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Brian J Kopp
- Surgical-Trauma ICU, Banner - University Medical Center Tucson, Tucson, AZ, USA
| | - Andrew L Tang
- Department of Surgery, Banner - University Medical Center, Tucson, AZ, USA
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Wick EH, Deutsch B, Kallogjeri D, Chi JJ, Branham GH. Effectiveness of Prophylactic Preoperative Antibiotics in Mandible Fracture Repair: A National Database Study. Otolaryngol Head Neck Surg 2021; 165:798-808. [PMID: 33845666 DOI: 10.1177/01945998211004270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This is the first database study to assess the effectiveness of prophylactic preoperative antibiotics (PPAs) in mandible fracture repair. STUDY DESIGN Retrospective cohort. SETTING Database study using US inpatient and outpatient insurance claims submitted from July 2006 to March 2015. METHODS The IBM MarketScan Commercial Database was queried for adults aged 18 to 64 years who had undergone first-time mandible fracture repair according to Current Procedural Terminology codes for open and closed repair. Primary outcomes included surgical revision, local infection, and osteomyelitis. Rates were compared between cohorts based on whether or not patients had filled antibiotic prescriptions during the preoperative period alone. The effects of drug abuse and type of mandible repair (open vs closed) were explored. Multivariate Poisson regression models were used to calculate adjusted relative risk estimates, and 95% CIs were used to determine statistically significant differences. RESULTS A total of 2676 patients were included, with 847 (31.7%) filling PPAs and 1829 (68.3%) filling no antibiotics. Rates were 38.9% for revision, 5.8% for local infection, and 2.1% for osteomyelitis. After multivariate analysis, exposure to PPAs was not associated with surgical revision (adjusted relative risk, 1.04; 95% CI, 0.94-1.15), local infection (1.16; 0.82-1.64), or osteomyelitis (1.21; 0.68-2.14). Patients were more likely to fill PPAs if they underwent open repair (35.3%) versus closed (26.6%) (proportion difference, 8.7%; 95% CI, 5.2%-12.2%), but exposure to antibiotics did not predict outcomes on subgroup analysis. CONCLUSION PPAs do not improve mandible repair outcomes, regardless of repair type.
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Affiliation(s)
- Elizabeth H Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Brian Deutsch
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Gregory H Branham
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Nishimoto RN, Dodson TB, Dillon JK, Lustofin SV, Lang MS. Is Distance Between Home and Treatment Site a Risk Factor for Complications After Treating Mandibular Fractures? J Oral Maxillofac Surg 2021; 79:1528.e1-1528.e8. [PMID: 33773968 DOI: 10.1016/j.joms.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Our level I trauma center provides care over a large geographic area including Alaska, Washington, Idaho, Montana, and Wyoming, with many patients traveling hundreds of miles to receive care. Distance to a treatment site is documented to be an independent risk factor for complications after multisystem trauma, but it is unclear if it is a risk factor for isolated mandibular fractures. The study purpose was to measure the association between distance to treatment site and risk for postoperative complications after treatment of isolated mandibular fractures. MATERIALS AND METHODS The investigators designed and implemented a retrospective cohort study and enrolled a sample derived from patients treated for isolated mandibular fractures at Harborview Medical Center by the oral and maxillofacial surgery service between June 2012 and December 2016. The primary predictor variable was distance (miles) between the patient's residence and site of treatment (Harborview Medical Center). The primary outcome variable was postoperative complication (yes or no), subcategorized as major and minor. Secondary outcome variables were time to treatment between injury and operative treatment (days) and length of hospital stay (LOS) (days). Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between distance to treatment site and postoperative complications, time to treatment, and LOS. The level of statistical significance was set at P ≤ .05. RESULTS The study sample was composed of 403 subjects with a mean age of 32.6 ± 14.3 years and 80% were men. The average distance from the patient's residence to treatment site was 44.8 ± 128.6 miles (range, 0 to 1,440 miles; median, 20.4 miles). Major complications occurred in 11.6% of patients. The average distance between patients with and without postoperative complications was not significantly different (42.3 ± 55.8 miles vs 45.5 ± 141.7 miles; P = .8). Increasing distance was significantly associated with longer LOS (r = 0.16; P < .001) but not time to treatment (r = .04; P = .4). CONCLUSIONS In contrast to other studies regarding multisystem trauma, complications after treating isolated mandible fractures were not associated with increasing distance to treatment site. Increasing distance may be associated with longer LOS but not time to treatment.
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Affiliation(s)
- Rodney N Nishimoto
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
| | - Thomas B Dodson
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Jasjit K Dillon
- Clinical Associate Professor, Program Director, Chief of Service, Harborview Medical Center, University of Washington School of Dentistry, Seattle, WA
| | - Stephanie V Lustofin
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Melanie S Lang
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
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Chaudhry H, Hennedige A, Patel M. Review of prophylactic prescribing of antibiotics during the management of fractured mandibles. Surgeon 2021; 19:e519-e525. [PMID: 33582055 DOI: 10.1016/j.surge.2020.12.009] [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: 08/05/2020] [Revised: 12/14/2020] [Accepted: 12/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To provide evidence based guidance on the optimum prophylactic antibiotic prescribing regimens in the treatment of fractured mandibles to protect against surgical site infections. MATERIAL AND METHODS OVID and Pubmed databases were searched for articles published between 1946 and 2020. Inclusion criteria was for articles to be in English, involve adult patients aged 14 and over, and involve patients treated with oral or IV antibiotics preoperatively, perioperatively or postoperatively during treatment of open or closed fractures of the mandible. Exclusion criteria included infected fractures on presentation, immunocompromised patients, fractures resulting from gunshot and pathological fractures. RESULTS A number of retrospective and prospective, randomised, double blind placebo-controlled trials were identified as suitable for inclusion. The age range within these trials was 14-77 years old. The numbers of patients contained within each trial ranged from 30 to 642. The most commonly prescribed antibiotics were penicillin, administered orally or intravenously. Duration of administration ranged from hospital admission to five days postoperatively. Analysis of these studies failed to demonstrate a statistical difference on the number of surgical site infections and the duration of antibiotic course. CONCLUSIONS The available evidence reveals no statistical difference in infection rates whether antibiotics are prescribed pre, peri, or postoperatively. The duration of antibiotics therapy also appears not to be important. Current evidence does not support the recommendation of an optimum antibiotic prescribing regimen. Additional prospective studies looking at the duration and timing of antibiotics during the management of fractured mandibles are required to identify the optimum prescribing regimen.
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Affiliation(s)
- Hiba Chaudhry
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom.
| | - Anusha Hennedige
- Department of Craniofacial Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Manu Patel
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom
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18
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Outcomes following use of a standard antibiotic protocol in the management of maxillofacial trauma patients. J Oral Biol Craniofac Res 2020; 10:519-522. [PMID: 32904248 DOI: 10.1016/j.jobcr.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effectiveness of a standard antibiotic regimen protocol in the management of maxillofacial trauma patients. Materials and methods The study sample included patients with at least one facial fracture and managed by either closed (CR/MMF) or open reduction (ORIF) by the Oral and Maxillofacial Surgery service. A standardized antibiotic administration protocol based on type of treatment performed and timing of surgical intervention was used in the management of all patients. The primary predictor variable was antibiotic usage. The primary outcome measured was postoperative surgical site infection. Bivariate analysis was performed to assess the association between antibiotic exposure and postoperative surgical site infection. A p value of less than or equal to .05 was deemed to be significant. Results The study sample comprised of 392 patients (102 midface and 290 mandible fractures). The mean age of the study group was 35 years and 89% of the patients were male. Postoperative infection was encountered in 18 patients (all with compound mandible fractures). The infection rates were 3.6% after CR/MMF and 8.7% after ORIF. No patient with midface fractures developed an infection. Chi-square test showed no statistically significant difference in postoperative infection rate in mandible fractures treated either by CR/MMF (p = 0.91) or ORIF (p = 0.94). Conclusions Use of this antibiotic administration protocol limits antibiotic usage and standardizes their administration in the management of maxillofacial trauma without increasing the rate of postoperative surgical site infections.
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Forrester JD, Wolff CJ, Choi J, Colling KP, Huston JM. Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures. Surg Infect (Larchmt) 2020; 22:274-282. [PMID: 32598227 DOI: 10.1089/sur.2020.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Facial fractures are common in traumatic injury. Antibiotic administration practices for traumatic facial fractures differ widely. Methods: The Surgical Infection Society's (SIS's) Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic administration in the management of traumatic facial fractures. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Pre-operative antibiotics were defined as those administered more than 1 hour before surgery. Peri-operative antibiotics were those administered within 1 hour of the start of surgery depending on the type of antibiotic and as late as ≤24 hours after surgery. Post-operative antibiotics were defined as those administered >24 hours after surgery. Prophylactic antibiotics were those administered for >24 hours without a documented infection. Evaluation of the published evidence was performed with the GRADE system. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: We recommend that in adult patients with non-operative upper face, midface, or mandibular fractures, prophylactic antibiotics not be prescribed and that in adult patients with operative, non-mandibular fractures, pre-operative antibiotics likewise not be prescribed. We recommend that in adult patients with operative, mandibular fractures, pre-operative antibiotics not be prescribed; and in adult patients with operative, non-mandibular facial fractures, post-operative (>24 hours) antibiotics again not be prescribed. We recommend that in adult patients with operative, mandibular facial fractures, post-operative antibiotics (> 24 hours) not be prescribed. Conclusions: This guideline summarizes the current SIS recommendations regarding antibiotic management of patients with traumatic facial fractures.
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Affiliation(s)
- Joseph D Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Chris J Wolff
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Jeff Choi
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | | | - Jared M Huston
- Departments of Surgery and Science Education, Zucker School of Medicine, Northwell Health, Hempstead, New York, USA
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20
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Zein Eddine SB, Cooper-Johnson K, Ericksen F, Brookes CC, Peppard WJ, Revolinski SL, Carver TW. Antibiotic Duration and Outcome Complications for Surgical Site Infection Prevention in Traumatic Mandible Fracture. J Surg Res 2019; 247:524-529. [PMID: 31668431 DOI: 10.1016/j.jss.2019.09.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/10/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The appropriate duration of antibiotic therapy for surgical site infection (SSI) prevention in traumatic mandibular fracture repair is unknown, and practices vary significantly. The objective of this study was to characterize antibiotic duration and outcomes after surgical repair of traumatic mandibular fracture. METHODS A single-center, retrospective analysis of all adult patients who underwent surgical fixation of a mandible fracture between January 2014 and December 2016 was performed. Operative service was categorized between otolaryngology (ear, nose, and throat surgery), plastic and reconstructive surgery, and oral and maxillofacial services. Primary outcomes were SSI and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). Differences in antibiotic prescription pattern were analyzed using analysis of variance test and Pearson chi-squared test. RESULTS A total of 75 patients were included in the study with 33 (44.0%), 26 (34.7%), and 16 (21.3%) managed by plastic and reconstructive surgery, ear, nose, and throat surgery, and oral and maxillofacial services, respectively. Median age was 30.0 y. Median injury severity score was 4.0. There was no significant difference in hospital length of stay (P = 0.44), intensive care unit length of stay (P = 0.53), or postoperative complications (P = 0.15). None of our patients developed an SSI or postantibiotics complications. Although the total inpatient duration of antibiotics was not significantly different among services (P = 0.37), there were significant differences in outpatient duration of antibiotics (P = 0.007) and total duration of antibiotics (P = 0.003). CONCLUSIONS Duration of antibiotics is not associated with postoperative SSI or antibiotics-related complications. The wide variation in prescribing practices and lack of any clear benefit for prolonged antibiotics provides an opportunity to explore the benefits of a standardized short course of antibiotics. LEVEL OF EVIDENCE Therapeutic study, III.
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Affiliation(s)
- Savo Bou Zein Eddine
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kaitlin Cooper-Johnson
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Forrest Ericksen
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carolyn C Brookes
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology and Communication Science, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William J Peppard
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sara L Revolinski
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas W Carver
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Delaplain PT, Phillips JL, Lundeberg M, Nahmias J, Kuza CM, Sheehan BM, Murphy LS, Pejcinovska M, Grigorian A, Gabriel V, Barie PS, Schubl SD. No Reduction in Surgical Site Infection Obtained with Post-Operative Antibiotics in Facial Fractures, Regardless of Duration or Anatomic Location: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2019; 21:112-121. [PMID: 31526317 DOI: 10.1089/sur.2019.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: We performed a systematic review of the literature on antibiotic prophylaxis practices in open reduction, and internal fixation of, facial fracture(s) (ORIFfx). We hypothesized that prolonged antibiotic prophylaxis (PAP) would not decrease the rate of surgical site infections (SSIs). Methods: We performed a systematic review of four databases: PubMed, CENTRAL, EMBase, and Web of Science, from inception through January 15, 2017. Three independent reviewers extracted fracture location (orbital, mid-face, mandible), antibiotic use, SSI incidence, and time from injury to surgery. Mantel-Haenszel and generalized estimating equations were carried out independently for each fracture zone. Results: Of the 587 articles identified, 54 underwent full-text review, yielding 27 studies that met our inclusion criteria. Of these, 16 studies (n = 2,316 patients) provided data for mandible fractures, four studies (n = 439) for mid-face fractures, and six studies (n = 377) for orbital fractures. Pooled analysis of each fracture type's SSI rate showed no statistically significant association with the odds ratio (OR) of developing an SSI. For mandible fractures treated with ORIFfx, the OR for an SSI after 24-72 hours of prophylaxis relative to <24 hours was 0.85 (95% confidence interval [CI] 0.62-1.17), whereas for >72 hours compared with <24 hours, the OR was 1.42 (95% CI) 0.96-2.11). For mid-face fractures, there was no improvement in SSI rate from PAP (OR 1.05; 95% CI 0.20-5.63). Conclusions: We did not demonstrate a lower rate of SSI associated with PAP for any ORIFfx repair. Post-operative antibiotics for >72 hours paradoxically may increase the SSI risk after mandible fracture repairs.
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Affiliation(s)
- Patrick T Delaplain
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Jacquelyn L Phillips
- Department of Surgery, University of California, San Francisco East Bay, San Francisco, California
| | | | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Catherine M Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, California
| | - Brian M Sheehan
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Linda S Murphy
- Reference Department, University of California-Irvine Libraries, NS, University of California, Irvine, Irvine, California
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California, Irvine, Irvine, California
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Viktor Gabriel
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Philip S Barie
- Department of Surgery, Weill Cornell Medical College at New York/Presbyterian Hospital, New York, New York
| | - Sebastian D Schubl
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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22
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Tyler D, Wong JLY, Krishnan O, Carter L. Antimicrobial regimens used in the treatment of mandibular fractures in UK maxillofacial units: changes over 12 years. Br J Oral Maxillofac Surg 2019; 58:89-91. [PMID: 31519439 DOI: 10.1016/j.bjoms.2019.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
In the case of most mandibular fractures, the prescription of antimicrobials for more than 24 hours postoperatively confers no clinical benefit. To establish the prescribing patterns for mandibular fractures in UK OMFS units, and to compare them with those used 12 years ago, we did a telephone and email survey of OMFS units in the UK. Antimicrobials were prescribed for more than 24 hours postoperatively by 76 units (65%) (considerably fewer than the 82 (87%) in 2005). The most commonly prescribed first-line antimicrobial was co-amoxiclav (75%). Although there has been some improvement since 2005, most units still prescribe antimicrobials for periods longer than 24 hours. National collaboration may improve their appropriate prescription.
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Affiliation(s)
- D Tyler
- Maxillofacial Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX.
| | - J L Y Wong
- Maxillofacial Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX.
| | - O Krishnan
- Maxillofacial Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX.
| | - L Carter
- Maxillofacial Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX.
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Hurrell M, David M, Batstone M. Patient compliance and mandible fractures: a prospective study. Int J Oral Maxillofac Surg 2019; 48:759-768. [DOI: 10.1016/j.ijom.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/18/2018] [Accepted: 11/23/2018] [Indexed: 11/16/2022]
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24
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A systematic review of latest evidence for antibiotic prophylaxis and therapy in oral and maxillofacial surgery. Infection 2019; 47:519-555. [DOI: 10.1007/s15010-019-01303-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/27/2019] [Indexed: 01/23/2023]
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25
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Habib AM, Wong AD, Schreiner GC, Satti KF, Riblet NB, Johnson HA, Ossoff JP. Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta-analysis. Laryngoscope 2018; 129:82-95. [DOI: 10.1002/lary.27210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Andy M. Habib
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
| | - Alexander D. Wong
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
| | - Geoffrey C. Schreiner
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Komal F. Satti
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Natalie B. Riblet
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
| | - Heather A. Johnson
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
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Linkugel AD, Odom EB, Bavolek RA, Snyder-Warwick AK, Patel KB. Systemic Preoperative Antibiotics with Mandible Fractures: Are They Indicated at the Time of Injury? Craniomaxillofac Trauma Reconstr 2017; 11:35-40. [PMID: 29387302 DOI: 10.1055/s-0037-1603458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022] Open
Abstract
Mandible fractures are the most common result of facial trauma. The proximity of oral flora to the site of both the injury and resulting surgical instrumentation makes managing infection a unique challenge. The benefit of antibiotic prophylaxis at the time of surgical treatment of mandible fractures is well established. However, the routine use of antibiotics between the time of injury and surgery is of unclear benefit. We aim to define the role of antibiotics in the preoperative period: from the time of injury to surgical intervention. Demographic and clinical data were collected retrospectively on all patients who were treated for mandible fracture by the Division of Plastic and Reconstructive Surgery at our institution between 2003 and 2013. The use of both preoperative (between injury and surgery) and perioperative (at the time of surgery) systemic antibiotics was recorded along with the incidence of postoperative infections and other complications. Complete data were available for 269 patients. Of the 216 patients who received preoperative antibiotics, 22 (10%) developed an infection postoperatively. Of the 53 patients who did not receive preoperative antibiotics, 2 (4%) developed infection ( p = 0.184). Likewise, preoperative antibiotics were not significantly associated with hardware complication rates. In our retrospective review, the use of antibiotics between injury and surgical repair had no impact on postoperative infection rates. These data suggest that preoperative antibiotic use may actually be associated with an increased incidence of postoperative infection. Our results do not support the routine use of antibiotics between injury and surgical repair in patients with mandible fractures.
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Affiliation(s)
- Andrew D Linkugel
- Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Elizabeth B Odom
- Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Rebecca A Bavolek
- Division of Emergency Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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27
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Alsharif U, Al-Moraissi E, Alabed S. Systemic antibiotic prophylaxis for preventing infectious complications in maxillofacial trauma surgery. Hippokratia 2017. [DOI: 10.1002/14651858.cd012603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ubai Alsharif
- Charite-Universitatsmedizin Berlin; Chariteplatz 1 Berlin Germany 10117
| | - Essam Al-Moraissi
- Thamar University; Department of Oral and Maxillofacial Surgery; Radaa Street Thamar Thamar Yemen
| | - Samer Alabed
- University of Sheffield; Academic Unit of Radiology; Sheffield UK
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