面对面部骨折预防用抗生素的事实：1 天或更短。
Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less.
机构信息
From the Department of Surgery (B.M.Z., C.W.E., D.E.K., F.J., V.P.H., J.A.C.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
出版信息
J Trauma Acute Care Surg. 2018 Sep;85(3):444-450. doi: 10.1097/TA.0000000000002009.
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.
背景
为了评估初始预防性抗生素对面部骨折的作用，我们比较了接受短期（≤24 小时）抗生素治疗和接受长期（>24 小时）抗生素治疗的患者的结局。
方法
纳入了 2010 年至 2015 年期间在一级创伤中心重症监护病房住院的至少有一处面骨骨折且头颈部有单一严重损伤的成年人。我们的主要分析比较了接受短期和长期抗生素预防治疗的患者头颈部感染（H/N 感染）的发生率。进行了多变量逻辑回归和倾向评分匹配对分析。
结果
共纳入 403 例患者，85.6%为钝器伤，72.7%的面骨骨折采用非手术治疗。H/N 感染率为 11.2%。280 例患者接受了短期抗生素治疗，123 例患者接受了长期抗生素治疗。两组的损伤严重度评分中位数均为 14（p=0.78）。接受长期抗生素治疗的患者 H/N 感染发生率更高（20.3% vs. 7.1%，p<0.001）。与 H/N 感染发生相关的因素包括年龄较小、穿透性损伤、开放性骨折、面中部或下颌骨骨折、多处面骨三分之一骨折、血管损伤、高血压和长期抗生素治疗。多变量逻辑回归确定了年龄较小（优势比[OR]，0.98；95%置信区间[CI]，0.96-1.00；p=0.02）、多处面骨三分之一骨折（OR，4.9；95%CI，2.4-10.2；p<0.001）和穿透性损伤机制（OR，3.1；95%CI，1.5-6.4；p=0.003）是 H/N 感染的独立预测因素，但抗生素持续时间不是。倾向评分匹配分析发现，短期和长期抗生素治疗的 H/N 感染发生率无差异（11.4% vs. 12.5%；p=1.0）。亚组分析显示，按损伤模式、机制或治疗方法（手术或非手术），短期或长期抗生素治疗的 H/N 感染率无差异。
结论
这些结果使我们认为，对于面部骨折患者，应将抗生素治疗时间限制在入院后 24 小时或更短时间内。
证据水平
治疗/护理管理，IV 级。
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