Antibiotic prophylaxis in the management of complex midface and frontal sinus trauma.

Abstract

OBJECTIVES/HYPOTHESIS:

Although mandible trauma has been studied extensively, there is no standard for use of pre- and postoperative antibiotics in other facial trauma. We sought to determine whether antibiotic strategies have an effect on infection rates.

STUDY DESIGN:

Retrospective chart review and cohort analysis.

METHODS:

Patients seen by the otolaryngology service for traumatic facial injuries between January 1, 2003 and January 1, 2009, were included in a retrospective cohort analysis (N = 223). All patients received perioperative antibiotic coverage. Isolated mandible fractures were excluded.

RESULTS:

Patient demographics were 73% male and 27% female, with an average age of 35 years (range, 8-81 years). The most common causes of trauma were assault (39%), motor vehicle accidents (28%), and falls (11%). The overall infection rate was 9%. There was no significant difference (P = .248) between infection rates for patients in each antibiotic group (preoperative, postoperative, pre- and postoperative, only perioperative). Infection rate was independently correlated with both number of fractures (P < .0001) and open fracture wounds (P = .034). There was no significant difference in infection rate between patients who received only perioperative antibiotics and those who received additional antibiotics (P = .997). However, the cohort with the most antibiotic use (pre-, peri-, and postoperative) had more severe facial injuries than the cohort that received only perioperative antibiotics.

CONCLUSIONS:

The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such antibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds. Laryngoscope, 2010.

• Authors: Alexander Lauder, Scharukh Jalisi, Jeffrey Spiegel, John Stram, Anand Devaiah
• Journal: The Laryngoscope (Laryngoscope) Vol. 120 Issue 10 Pg. 1940-5 (Oct 2010) ISSN: 1531-4995 [Electronic] United States
• PMID: 20824781 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antibiotic Prophylaxis
• Chi-Square Distribution
• Child
• Facial Injuries (surgery)
• Female
• Frontal Sinus (injuries, surgery)
• Humans
• Male
• Middle Aged
• Multiple Trauma (surgery)
• Retrospective Studies
• Skull Fractures (surgery)
• Surgical Wound Infection (prevention & control)
• Trauma Severity Indices
• Treatment Outcome