抗生素使用时机与 Gustilo-Anderson Ⅲ型开放性胫骨骨折深部手术部位感染的相关性
Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia Fractures.
作者信息
Okhuereigbe David, Raffetto Michael, Li Vivian, Bell Alice, Lawrence Joshua E, Kim Joanna, Stennett Christina A, Slobogean Gerard P, O'Hara Nathan N, O'Toole Robert V
机构信息
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
出版信息
J Orthop Trauma. 2025 Apr 16. doi: 10.1097/BOT.0000000000002996.
OBJECTIVES
To determine the association between the timing of antibiotic delivery in the emergency department (ED) and deep surgical site infection in Gustilo-Anderson (GA) type III open tibia fractures.
METHODS
Design: Retrospective cohort study.
SETTING
Single Level I Trauma Center.
PATIENT SELECTION CRITERIA
Patients aged ≥18 years with a Gustilo-Anderson (GA) type III open tibia fracture (OTA/AO 41, 42, or 43) from 2016 to 2021 were included.
OUTCOME MEASURES AND COMPARISONS
The outcome was deep surgical site infection requiring irrigation and debridement. The effect of time of delivery of antibiotics was compared in 3 analyses: as a continuous variable, before vs after 60 minutes, and before vs after 180 minutes. The study analysis accounted for known confounders for infection, including Injury Severity Score (ISS), GA classification, and wound contamination.
RESULTS
The study population included 191 patients with a mean age of 44 years (SD: 17) and 153 males. The median time from arrival to the first antibiotic was 44 minutes (IQR: 21-147). The majority of patients (99.0%) received cephazolin as their initial antibiotic. The overall 90-day risk of deep surgical site infection requiring irrigation and debridement was 10.5%. The timing of antibiotic administration as a continuous variable was not associated with infection (aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39). Similarly, time to antibiotic administration was not associated with infection at thresholds of 1 hour (aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96) or 3 hours (aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89) in separate models.
CONCLUSIONS
Early antibiotic administration was not associated with a reduced risk of deep surgical site infection in GA type III tibia fractures. These results suggest that the acute timing of antibiotics may not be as impactful to patients' risk of infection as once considered.
LEVEL OF EVIDENCE
Therapeutic, Level III.
目的
确定急诊科（ED）抗生素给药时间与 Gustilo-Anderson（GA）III 型开放性胫骨骨折深部手术部位感染之间的关联。
方法
设计：回顾性队列研究。
地点
单一的 I 级创伤中心。
患者选择标准
纳入 2016 年至 2021 年年龄≥18 岁、患有 Gustilo-Anderson（GA）III 型开放性胫骨骨折（OTA/AO 41、42 或 43）的患者。
结果测量与比较
结果为需要冲洗和清创的深部手术部位感染。在三项分析中比较了抗生素给药时间的影响：作为连续变量、60 分钟之前与之后、180 分钟之前与之后。研究分析考虑了已知的感染混杂因素，包括损伤严重程度评分（ISS）、GA 分类和伤口污染情况。
结果
研究人群包括 191 名患者，平均年龄 44 岁（标准差：17），男性 153 名。从到达医院到首次使用抗生素的中位时间为 44 分钟（四分位间距：21 - 147）。大多数患者（99.0%）接受头孢唑林作为初始抗生素。需要冲洗和清创的深部手术部位感染的总体 90 天风险为 10.5%。抗生素给药时间作为连续变量与感染无关（调整后比值比：1.00，95%置信区间：0.99 - 1.00，P = 0.39）。同样，在单独的模型中，在 1 小时（调整后比值比：1.02，95%置信区间：0.39 - 2.68，P = 0.96）或 3 小时（调整后比值比：1.08，95%置信区间：0.35 - 3.37，P = 0.89）的阈值下，抗生素给药时间与感染无关。
结论
早期使用抗生素与 GA III 型胫骨骨折深部手术部位感染风险降低无关。这些结果表明，抗生素给药的急性时机对患者感染风险的影响可能不像曾经认为的那样大。
证据水平
治疗性，III 级。
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