1
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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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2
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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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3
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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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4
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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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5
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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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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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7
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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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8
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Wong K, Wong A, Rousso JJ. Reconstructive Options for Auricular Trauma. Facial Plast Surg 2021; 37:510-515. [PMID: 33853136 DOI: 10.1055/s-0041-1726465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Given its prominent lateral position, the auricle is a common site of injury after blunt trauma. Auricular injuries can lead to both functional and aesthetic complications. A careful history and examination will help determine the mechanism of injury and identify factors that may influence repair. Auricular reconstruction is highly individualized and depends on the size, location, and nature of injury. Understanding the complex three-dimensional anatomy of the external ear is a necessity for appropriate reconstruction. This article reviews the reconstructive options for simple and complex auricular injuries based on the anatomical site and the intricate three-dimensional structures that form the auricle.
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Affiliation(s)
- Kevin Wong
- Department of Otolaryngology, The Mount Sinai Hospital, New York, New York.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Anni Wong
- Department of Otolaryngology, The Mount Sinai Hospital, New York, New York.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Joseph J Rousso
- Department of Otolaryngology, The Mount Sinai Hospital, New York, New York.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.,Division of Facial Plastic Surgery, Manhattan Facial Plastic Surgery, New York, New York
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9
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Use of antibiotics in traumatic mandibular fractures: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59:1140-1147. [PMID: 34711441 DOI: 10.1016/j.bjoms.2021.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/30/2021] [Indexed: 12/25/2022]
Abstract
The treatment of traumatic mandibular fractures constitutes a significant part of the oral and maxillofacial trauma service's workload. There are potential variations in how they are managed. Patients are often admitted and given intravenous antibiotics prior to their definitive treatment. The evidence behind this is inconclusive. We performed a systematic review as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance/ PROSPERO Registered (CRD:42020201398) on the use of antibiotics in the management of mandibular fractures. We identified studies using a search algorithm within the OVID Gateway (including MEDLINE, PubMed, and Cochrane Collaborative). Studies analysing the possible impact of prophylactic antibiotics on traumatic mandibular fractures were eligible. The primary outcome was surgical site infection requiring any treatment beyond the normal postoperative protocol. Secondary outcomes included any complication requiring further intervention. From the 16 studies identified (3,285 patients), seven were randomised controlled clinical trials (RCTs) and nine were retrospective observational studies. We have identified significant between-study variation in choice of antibiotic regimen (timing, dosage, duration) and in reporting both primary and secondary outcomes. There was significant between-study heterogeneity (p = 0.02, I2 = 69%) and none of the assessed interventions was found to be superior. The evidence behind the use of prophylactic antibiotics in mandibular fractures is weak. A properly designed and powered RCT is needed, in order to standardise practice for the benefit of patients and healthcare systems.
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10
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Zosa BM, Ladhani HA, Sajankila N, Elliott CW, Claridge JA. Pre-Operative Antibiotic Agents for Facial Fractures: Is More than One Day Necessary? Surg Infect (Larchmt) 2020; 22:516-522. [PMID: 33035118 DOI: 10.1089/sur.2020.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Despite a paucity of evidence, patients with facial fractures often receive long courses of pre-operative antibiotic agents. This study compared the effect of a short versus long pre-operative antibiotic course on the development of post-operative head/neck infections in this population. Patients and Methods: All adult patients admitted between January 2010 and May 2015 to a level 1 trauma center with isolated head/neck injuries who underwent surgery for facial fracture(s) were included. Patients with infections prior to surgery were excluded. Our primary analysis compared head/neck infections between patients given a short (≤24 hours) versus long (>24 hours) course of pre-operative antibiotic agents. Bivariate analysis and multivariate logistic regression (MLR) were performed to identify risk factors for head/neck infections. Results: This study included 188 patients; median age was 38.5 years, 83% were male, 81% had blunt injuries, 51.6% had fractures in multiple facial thirds, and 48.9% required intensive care unit (ICU) admission. One hundred twenty-five (66.5%) patients received a short course and 63 (33.5%) received a long course of pre-operative antibiotic agents. Head/neck infections were higher in the long course group (28.6% vs 15.2%; p = 0.034), but median days to infection were similar. Factors associated with head/neck infections included penetrating injury, mandible fracture, involvement of multiple facial thirds, ICU admission, operative time, and receiving a long pre-operative antibiotic course. Multivariable logistic regression found mandible fracture (odds ratio [OR], 2.9; p = 0.01) and ICU admission (OR, 3.3; p = 0.003) to be independent predictors of head/neck infections (area under the curve [AUC] = 0.706), but pre-operative antibiotic course was not. Patients with isolated mandible fractures (n = 42) had higher rates of head/neck infections in the long course group (29.4% vs 4.0%; p = 0.032), despite similar demographics. Conclusion: Long (>24 hours) course of continuous pre-operative antibiotic prophylaxis before surgery for facial fractures did not reduce the development of head/neck infections.
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Affiliation(s)
- Brenda M Zosa
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Husayn A Ladhani
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Nitin Sajankila
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Charles W Elliott
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Jeffrey A Claridge
- Department of Surgery, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
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11
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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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12
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Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less. J Trauma Acute Care Surg 2019; 85:444-450. [PMID: 29985240 DOI: 10.1097/ta.0000000000002009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours). METHODS Adults admitted (2010-2015) to a Level I trauma center intensive care unit with at least one facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis. Multivariate logistic regression and analysis of propensity score matched pairs were performed. RESULTS A total of 403 patients were included, 85.6% had blunt injuries and 72.7% had their facial fracture managed nonoperatively. The H/N infection rate was 11.2%. Two hundred eighty patients received a short course of antibiotics and 123 patients received an extended course. Median Injury Severity Score was 14 in both groups (p = 0.78). Patients receiving an extended course of antibiotics had higher rates of H/N infection (20.3% vs. 7.1%, p < 0.001). Factors associated with development of H/N infection included younger age, penetrating injury, open fracture, upper face or mandible fracture, fractures in multiple facial thirds, vascular injury, hypertension, and extended antibiotic course. Multivariate logistic regression identified younger age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-1.00; p = 0.02), multiple facial third fractures (OR, 4.9; 95% CI, 2.4-10.2; p < 0.001), and penetrating mechanism (OR, 3.1; 95% CI, 1.5-6.4; p = 0.003) as independent predictors of H/N infection, but not antibiotic duration. Propensity score-matched analysis found no differences in H/N infection between short and extended antibiotic courses (11.4% vs. 12.5%; p = 1.0). Subgroup analyses demonstrated no differences in H/N infection between short or extended antibiotic courses by injury pattern, mechanism, or treatment (operative or nonoperative). CONCLUSION These results lead us to believe that we should limit antibiotics to 24 hours or less upon admission for facial fractures. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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13
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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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14
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Antibiotic use in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2018; 26:242-247. [PMID: 29750669 DOI: 10.1097/moo.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review and discuss recent literature regarding perioperative use of antibiotics in the context of facial plastic surgery. RECENT FINDINGS Despite research efforts, there continues to be insufficient evidence in support of, or against, the use of antimicrobial prophylaxis. SUMMARY Current available evidence regarding antibiotic use in facial plastic surgery procedures fails to demonstrate routine benefit. Therefore, the advantages accompanying administration of preoperative antibiotics should be weighed against any potential complications on a case-by-case basis. Future large-scale prospective studies will be beneficial in developing standardized criteria directing appropriate antibiotic use.
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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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Hammond D, Parmar S, Whitty J, McPhillips M, Wain R. Prescription of antibiotics: does it alter the outcome for patients who have fractures of the angle of the mandible? Br J Oral Maxillofac Surg 2017; 55:958-961. [DOI: 10.1016/j.bjoms.2017.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
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MOURA LB, TRIVELLATO AE, FIGUEIREDO CE, GABRIELLI MAC, PEREIRA-FILHO VA. Comparação do índice de infecção pós-operatória em fraturas mandibulares lineares com o uso de profilaxia antibiótica. REVISTA DE ODONTOLOGIA DA UNESP 2017. [DOI: 10.1590/1807-2577.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução Infecções pós-operatórias representam a maior complicação no tratamento de fraturas mandibulares. A utilização de profilaxia antibiótica diminui os índices de infecção, entretanto sua manutenção após o procedimento cirúrgico é controversa na literatura. Objetivo Comparar o índice de infecção pós-operatória no tratamento de fraturas mandibulares lineares com ou sem profilaxia antibiótica pós-operatória. Metodologia Foi realizada uma análise retrospectiva transversal para verificar a presença de infecção pós-operatória. Trinta prontuários de pacientes portadores de fraturas mandibulares lineares, tratados por meio de acesso intrabucal e fixação interna estável, foram selecionados e divididos em dois grupos com 15 prontuários cada: pacientes que realizaram apenas profilaxia antibiótica pré-operatória e pacientes que realizaram profilaxia antibiótica pré e pós-operatória por seis dias. Resultado Foram observadas cinco infecções, sendo três no grupo que realizou apenas profilaxia pré-operatória e duas no grupo que fez uso de antibiótico após o procedimento. Conclusão Em fraturas mandibulares lineares, a utilização de antibiótico pós-operatório não reduziu o índice de infecções significantemente.
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Dedhia R, Hsieh TY, Tollefson TT, Ishii LE. Evidence-based Medicine in Facial Plastic Surgery. Facial Plast Surg Clin North Am 2016; 24:265-74. [DOI: 10.1016/j.fsc.2016.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Prophylactic antibiotic use in facial plastic surgery is a highly controversial topic primarily due to the lack of evidence in support of or against antibiotic use. In this section the authors present the available literature on the most commonly performed procedures within facial plastic surgery in an attempt to see if the data support or contradict the need for antibiotic prophylaxis in facial plastic surgery.
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Affiliation(s)
- Javier González-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, PO Box 16423, San Juan, PR 00908, USA.
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive H091, Hershey, PA 17033, USA
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Krishnan B. The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible. Craniomaxillofac Trauma Reconstr 2016; 9:20-8. [PMID: 26889344 DOI: 10.1055/s-0035-1556050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/21/2015] [Indexed: 01/08/2023] Open
Abstract
Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.
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Affiliation(s)
- Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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