Redfern Jenessa, Wasilko Scott M, Groth Meghan E, McMillian Wesley D, Bartlett Craig S
*Department of Pharmacy, University of Vermont Medical Center, Burlington, VT; and †Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT.
J Orthop Trauma. 2016 Aug;30(8):415-9. doi: 10.1097/BOT.0000000000000554.
The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis.
Retrospective cohort study.
Level 1 trauma center.
Seven hundred sixty-six patients admitted between January 1, 2004, and December 31, 2012, with open fractures were identified using the National Trauma Data Bank by searching International Classification of Diseases, Ninth Revision (ICD-9) codes. Electronic medical record review revealed 134 patients with type 3 open fractures, of which 72 were included in the final analysis.
Administration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis.
SSI, nonunion, death, and rehospitalization rates at 1 year.
Surgical site infection at 1 year occurred in 12 of 37 patients (32.4%) in the cefazolin plus gentamicin group and 11 of 35 patients (31.4%) in the piperacillin/tazobactam group (P = 1.000). Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups. Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group (21.6% vs. 11.4%; P = 0.246).
At our institution, use of piperacillin/tazobactam as compared with cefazolin plus gentamicin for antibiotic prophylaxis in patients with type 3 open fractures showed similar rates of SSI, nonunion, mortality, and rehospitalization at 1 year after injury.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在比较接受头孢唑林加庆大霉素与哌拉西林/他唑巴坦预防开放性骨折手术部位感染（SSI）的3型开放性骨折患者的感染率。
回顾性队列研究。
一级创伤中心。
通过搜索国际疾病分类第九版（ICD-9）编码，利用国家创伤数据库确定了2004年1月1日至2012年12月31日期间收治的766例开放性骨折患者。电子病历审查发现134例3型开放性骨折患者，其中72例纳入最终分析。
对3型开放性骨折患者采用头孢唑林加庆大霉素或哌拉西林/他唑巴坦进行抗生素预防。
1年时的手术部位感染、骨不连、死亡和再住院率。
头孢唑林加庆大霉素组37例患者中有12例（32.4%）在1年时发生手术部位感染，哌拉西林/他唑巴坦组35例患者中有11例（31.4%）发生手术部位感染（P = 1.000）。两组1年时的骨不连、死亡和再住院率相似。虽然两组之间30天时手术部位感染无统计学显著差异，但头孢唑林加庆大霉素组的感染率更高（21.6%对11.4%；P = 0.246）。
在我们机构，对于3型开放性骨折患者，使用哌拉西林/他唑巴坦与头孢唑林加庆大霉素进行抗生素预防相比，受伤后1年时的手术部位感染、骨不连、死亡率和再住院率相似。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
