Title : An Analysis of Infection Rates Following Midfacial Fractures and the Requirement of Antibiotic Use Prior to Surgery
Abstract:
Introduction:
Midfacial fractures are common injuries resulting from facial trauma with some cases requiring surgical management. Use of perioperative antibiotics two hours before surgery has proven to lower rates of surgical-site infections (SSI). However, data regarding the use of prophylactic antibiotics prior to this time frame is limited and there are no current standard recommendations for antibiotic prescribing in craniofacial surgery. The basis of treatment is generalized from recommendations for orthopaedic management of fractures and head and neck oncological procedures with influence by unique situations based specifically for craniofacial fractures (1). This includes potential contamination of fracture sites from sinuses, introduction of intraoral bacteria to exposed fractures through mucosal tears, and delay in management of fractures. Therefore, despite the definitive management of midface fractures the use of prophylactic/preoperative antibiotics have been adopted. The purpose of this study is to determine if prophylactic/preoperative antibiotics in conservatively or surgically managed midface fractures reduce rates of infection.
Methods:
1353 patients with nonoperative/operative midface fractures from two centers were included in the study and separated into two groups: those treated with broad-spectrum prophylactic/preoperative antibiotics and those without. Specific risk factors were documented that could affect infection rates. Antibiotics were used for various durations depending on timeframe of presentation and treatment plan. The antibiotics consisted of amoxicillin/clavulanate, clindamycin, cephalosporin, and/or metronidazole. Infection rates were determined by retrospective chart review over a 2 year period.
Results:
2 infections in 560 patients with no prophylactic/preoperative antibiotics and 1 infection in 793 patients that received antibiotics with risk of infection of 0.357% and 0.126% respectively. These results were not statistically significant.
Conclusion:
A study by Gillies et al showed the number needed to harm for diarrhea and candidiasis of 10 and 27 with the use of amoxicillin-clavulanate and amoxicillin alone respectively (2). Taking into consideration the rate of adverse events from antibiotics compared to our data showing a low infection rate despite no prophylactic/preoperative antibiotics, it is reasonable to consider withholding prophylactic/preoperative antibiotic prescription for midface fractures if certain risk factors do not exist.
