Department of Surgery, University of Tennessee at Knoxville Graduate School of Medicine, Knoxville, Tennessee, USA.
College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Surg Infect (Larchmt). 2022 Sep;23(7):675-681. doi: 10.1089/sur.2022.049. Epub 2022 Aug 4.
Antibiotic agents have been shown to improve outcomes in open extremity fractures. The first-generation cephalosporins, which are used most often, are often under-dosed based on weight and recommended frequency. Ceftriaxone offers a broader coverage and a decreased frequency of administration. Our institution began utilizing ceftriaxone for open fracture management in 2017 to address those concerns. To examine the efficacy of cefazolin versus ceftriaxone for open fracture management of extremity trauma. Retrospective study from 2015-2019 of patients who sustained open extremity fractures. Patients were stratified by antibiotic administered and Gustilo-Anderson grade. Outcomes included non-union/malunion, superficial surgical site infection (SSI), deep SSI, osteomyelitis, re-operation after index hospital visit, re-admission due to prior injury, limb loss, and death. Subgroup analysis stratified each antibiotic group by Gustilo-Anderson grade 1 or 2 and grade 3. Data was collected from 2015 to 2019. Of the 1,149 patients, 619 patients met inclusion criteria. Three hundred fifty-five patients received cefazolin and 264 patients received ceftriaxone. There were no statistically significant differences between groups on specified outcomes. No statistically significant differences existed during subgroup analysis for the specified outcomes. Multivariable analysis demonstrated increased Gustilo-Anderson grade increased risk of infectious outcome. Ceftriaxone is a safe and effective alternative for open fracture extremity management that offers the advantage of 24-hour dosing and single antibiotic coverage for grade 3 open fractures. It does not increase infectious complications and offers benefits of resource efficiency.
抗生素已被证明可改善开放性四肢骨折的预后。第一代头孢菌素是最常用的抗生素，但通常根据体重和推荐的使用频率来减少剂量。头孢曲松提供了更广泛的覆盖范围和更少的给药频率。我们医院于 2017 年开始使用头孢曲松来管理开放性骨折，以解决这些问题。
为了研究头孢唑林与头孢曲松在治疗四肢创伤开放性骨折中的疗效。这是一项回顾性研究，纳入了 2015 年至 2019 年期间发生开放性四肢骨折的患者。患者根据使用的抗生素和 Gustilo-Anderson 分级进行分层。研究结果包括骨折不愈合/畸形愈合、浅表手术部位感染（SSI）、深部 SSI、骨髓炎、索引就诊后再次手术、因先前损伤再次入院、肢体丧失和死亡。亚组分析按 Gustilo-Anderson 1 或 2 级和 3 级对每个抗生素组进行分层。
数据收集于 2015 年至 2019 年。在 1149 名患者中，有 619 名符合纳入标准。355 名患者接受头孢唑林治疗，264 名患者接受头孢曲松治疗。在指定的结果上，两组之间没有统计学上的显著差异。在指定结果的亚组分析中，也没有统计学上的显著差异。多变量分析表明，Gustilo-Anderson 分级增加会增加感染性结果的风险。
头孢曲松是治疗开放性四肢骨折的一种安全有效的替代方法，它提供了 24 小时剂量和单一抗生素覆盖范围的优势，适用于 3 级开放性骨折。它不会增加感染性并发症，并具有资源效率方面的优势。
