State of the Union: Timeliness to Antibiotics in Open Fractures.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 05 2023
01 05 2023
Historique:
accepted:
05
12
2022
medline:
24
4
2023
pubmed:
3
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
In open fractures, early administration of systemic antibiotics has recently been recognized as a universal recommendation, with the current American College of Surgeons Trauma Center Verification recommendation for administration within 1 hour of facility arrival. We sought to quantify the baseline rate of timely antibiotic administration and the various factors associated with delay. Data from the National Trauma Data Bank were obtained for all patients treated for open fractures in 2019. 65,552 patients were included. Univariate and multivariate analyses were performed, first for patient, prehospital, and hospital factors compared with rate of antibiotic administration within 1 hour of hospital arrival, then with a multivariate analysis of factors affecting these times. The overall rate of antibiotic administration within 1 hour of arrival was 47.6%. Patient factors associated with lower rates of timely antibiotics include increased age, Medicare status, and a higher number of comorbidities. Associated prehospital factors included non-work-related injuries, fixed-wing air or police transport, and walk-in arrival method. Patients with lower extremity open fractures were more likely to receive antibiotics within 1 hour of arrival than those with upper extremity open fractures. Traumatic amputations had a higher rate of timely administration (67.3%). ACS trauma Level II (52.5%) centers performed better than Level III (48.3%), Level I (45.5%), and Level IV (34.5%) centers. Multivariate analysis confirmed the findings of the univariate analysis. Despite current clinical standards, rates of adherence to rapid antibiotic administration are low. Certain patient, facility, and environmental factors are associated with delays in antibiotic administration and can be a focus for quality improvement processes. We plan to use these data to evaluate how focus on antibiotic administration as this quality standard changes practice over time. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 36729516
doi: 10.1097/BOT.0000000000002546
pii: 00005131-202305000-00014
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e213-e218Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Gustilo RB, Merkow RL, Templeman D. The management of open fractures. J Bone Joint Surg Am. 1990;72:299–304.
Garner MR, Sethuraman SA, Schade MA, et al. Antibiotic prophylaxis in open fractures: evidence, evolving issues, and recommendations. J Am Acad Orthop Surg. 2020;28:309–315.
Lin CA, O'Hara NN, Sprague S, et al. Low adherence to recommended guidelines for open fracture antibiotic prophylaxis. J Bone Joint Surg Am. 2021;103:609–617.
Lack WD, Karunakar MA, Angerame MR, et al. Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection. J Orthop Trauma. 2015;29:1–6.
Pollak AN, Jones AL, Castillo RC, et al. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am. 2010;92:7–15.
Penn-Barwell JG, Murray CK, Wenke JC. Early antibiotics and debridement independently reduce infection in an open fracture model. J Bone Joint Surg Br. 2012;94:107–112.
Obremskey W, Molina C, Collinge C, et al. Current practice in the management of open fractures among orthopaedic trauma Surgeons. Part A: initial management. A survey of orthopaedic trauma Surgeons. J Orthop Trauma. 2014;28:e198–e202.
Chang Y, Bhandari M, Zhu KL, et al. Antibiotic prophylaxis in the management of open fractures: a systematic survey of current practice and recommendations. JBJS Rev. 2019;7:e1.
American College of Surgeons. TQIP: Best Practices in the Management of Orthopedic Trauma; 2016. Available at: https://www.facs.org/media/mkbnhqtw/ortho_guidelines.pdf .
Shieh AK, Lucas JF, Shelton TJ, et al. National metrics improved timeliness of antibiotic administration for open extremity fractures. J Orthop Trauma. 2021;35:437–441.
Johnson JP, Goodman AD, Haag AM, et al. Decreased time to antibiotic prophylaxis for open fractures at a level one trauma center. J Orthop Trauma. 2017;31:596–599.
Harper KD, Quinn C, Eccles J, et al. Administration of intravenous antibiotics in patients with open fractures is dependent on emergency room triaging. PLoS One. 2018;13:e0202013.
Collinge CA, McWilliam-Ross K, Kelly KC, et al. Substantial improvement in prophylactic antibiotic administration for open fracture patients: results of a performance improvement program. J Orthop Trauma. 2014;28:620–625.