Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
Clinical Pharmacy Specialist, Trauma Critical Care, University Medical Center New Orleans, Clinical Assistant Professor, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
J Oral Maxillofac Surg. 2023 Jun;81(6):746-751. doi: 10.1016/j.joms.2023.02.011. Epub 2023 Mar 8.
While recent literature suggests antibiotics are not needed in patients with nonoperative facial fractures involving sinuses, the existing studies do not focus on critically injured patients who are known to be at higher risk for sinusitis and ventilator-associated pneumonia, which could be exacerbated by facial fractures.
The purpose of this study was to determine if antibiotics reduce the rate of infectious complications in critically injured patients who have blunt midfacial trauma treated nonoperatively.
STUDY DESIGN, SETTING, SAMPLE: The authors conducted a retrospective cohort study consisting of patients admitted to the trauma intensive care unit who sustained blunt midfacial injuries managed nonoperatively at an urban Level 1 trauma center from August 13th, 2012, to July 30th, 2020. Adults who were critically injured on admission and sustained a midfacial fracture involving a sinus were included in the study. Patients who underwent operative repair of any facial fracture were excluded.
The predictor variable was the use of antibiotics.
The primary outcome variable was the development of infectious complications, such as sinusitis, soft tissue infection, or any type of pneumonia, including ventilator-associated pneumonia (VAP).
The data were analyzed using Wilcoxon rank sum tests, Fisher exact tests, and multivariable logistic regression as appropriate for analysis type with significance level set at <0.05.
The study included 307 patients, with a mean age of 40.6 years. Men accounted for 85.0% of the study population. Antibiotics were administered to 229 (74.6%) of the study population. Complications developed in 13.6% of the patients, which included sinusitis (0.3%), VAP (7.5%), and other types of pneumonia (5.9%). Clostridioides difficile colitis developed in 2 patients (0.6%). Antibiotics were not associated with a decrease in infectious complications in either the unadjusted analysis (13.1% in antibiotic group, 15.4% in no antibiotic group, RR = 0.85 [95% confidence interval = 0.5 to 1.6], P = .7) or the adjusted analysis (odds ratio 0.74 [0.34 to 1.62]).
Even in this critically injured patient population thought to be at elevated risk for infectious complications from their midfacial fractures, the rates of infectious complications in those who received antibiotics and those who did not were no different. These results suggest that consideration of more judicious use of antibiotics is warranted in critically ill patients with nonoperative midface fractures.
虽然最近的文献表明，对于非手术治疗的涉及鼻窦的非手术面部骨折患者不需要使用抗生素，但现有研究并未关注已知鼻窦感染和呼吸机相关性肺炎风险较高的重症患者，而面部骨折可能会使这些风险进一步加剧。
本研究旨在确定在非手术治疗的钝性中面部创伤的重症患者中，使用抗生素是否可以降低感染并发症的发生率。
研究设计、地点和样本：作者进行了一项回顾性队列研究，纳入了 2012 年 8 月 13 日至 2020 年 7 月 30 日期间在城市一级创伤中心接受非手术治疗的创伤重症监护病房中因钝性中面部损伤而住院的患者。研究纳入了入院时处于重症状态且存在涉及鼻窦的中面部骨折的成年人。排除了接受任何面部骨折手术修复的患者。
预测变量为抗生素的使用。
主要结局变量是感染并发症的发生，如鼻窦炎、软组织感染或任何类型的肺炎，包括呼吸机相关性肺炎（VAP）。
使用 Wilcoxon 秩和检验、Fisher 确切检验和多变量逻辑回归进行数据分析，根据分析类型选择合适的检验方法，显著性水平设为<.05。
研究共纳入 307 例患者，平均年龄为 40.6 岁。男性占研究人群的 85.0%。229 例（74.6%）患者接受了抗生素治疗。13.6%的患者出现了并发症，包括鼻窦炎（0.3%）、VAP（7.5%）和其他类型的肺炎（5.9%）。2 例患者（0.6%）发生艰难梭菌结肠炎。在未校正分析中（抗生素组为 13.1%，无抗生素组为 15.4%，RR=0.85[95%置信区间为 0.5 至 1.6]，P=.7）和校正分析中（比值比 0.74[0.34 至 1.62]），抗生素的使用与感染并发症的减少均无相关性。
即使在这些被认为存在因中面部骨折而导致感染并发症风险较高的重症患者中，接受抗生素治疗和未接受抗生素治疗的患者的感染并发症发生率也没有差异。这些结果表明，对于非手术治疗的中面部骨折的重症患者，考虑更合理地使用抗生素是合理的。
