Effectiveness of an Evidence-Based Protocol on Antibiotic Stewardship, Infection Rate and Incidence of Drug-Induced Complications in Type III Open Fractures
Location
LSUHSC-NO Medical Education Building
Event Website
www.medschool.lsuhsc.edu/ortho/resident_programs.aspx
Document Type
Presentation
Start Date
23-6-2023 10:40 AM
End Date
23-6-2023 10:50 AM
Publication Date
June 2023
Description
Background: An open fracture is defined as fracture fragments in communication with the environment through a skin break. It is associated with high-impact trauma and poses a higher susceptibility to infection and soft tissue complications. The Gustillo and Anderson classification describes the severity of these fractures based on contamination, size of the laceration, degree of soft tissue injury, and presence of vascular compromise. Open fractures are categorized as Grade I, II, or III with the degree of severity increasing in numerical order (I-III). Risk of infection and limb loss correlates with the Gustilo type. Antibiotic prophylaxis is an important adjunct in preventing infections in open lower extremity fractures, with broader coverage recommended in higher-severity fractures. Duration and choice of antibiotic therapy continue to be an ongoing area of clinical research that remains variable between institutions. Appropriate antibiotic prophylaxis regimen is controversial, and many trauma centers use broad-spectrum antibiotic therapies for coverage of Grade III fractures. There is substantial morbidity associated with commonly used broad-spectrum antibiotics in the open fracture population including antimicrobial resistance and potential AKI with aminoglycoside and glycopeptide use. Recent studies have shown that the implementation of an evidence-based antibiotic prophylaxis protocol for open fractures results in significantly decreased use of aminoglycoside and glycopeptide antibiotics without an increase in skin and soft tissue infection rates. The primary objective of this study is to examine infection rates before and after implementing an evidence-based antibiotic prophylaxis protocol for open fractures at our institution. Secondary objectives include assessing the number of dose drug administrations, cost differences and incidence of AKI before and after protocol implementation. The hypothesis of this study is that the infection rate after implementation of an evidence-based protocol would be non-inferior to a broad-spectrum protocol with decreases in dose drug administration, cost and incidence of AKI. Methods: This is single-center retrospective study which identifies patients who were admitted for open long fractures of lower extremities including femur and tibia/fibula fractures from 06/01/2014 through 06/01/2022. It includes all patients who were diagnosed with Type III open lower extremity fracture in age group 18+. A retrospective chart review will identify all adults (age 18+) with Grade III open femur and open tibia/fibula fractures and will be conducted by querying the institution trauma database and Epic Slicer Dicer. A preliminary list of patients who meet the criteria will be abstracted and compared based on respective antibiotic groups for presentation. Results and Conclusions Pending
Recommended Citation
Willard, Jonathan, "Effectiveness of an Evidence-Based Protocol on Antibiotic Stewardship, Infection Rate and Incidence of Drug-Induced Complications in Type III Open Fractures" (2023). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 3.
https://digitalscholar.lsuhsc.edu/ortho_rd/2023/pres2/3
Effectiveness of an Evidence-Based Protocol on Antibiotic Stewardship, Infection Rate and Incidence of Drug-Induced Complications in Type III Open Fractures
LSUHSC-NO Medical Education Building
Background: An open fracture is defined as fracture fragments in communication with the environment through a skin break. It is associated with high-impact trauma and poses a higher susceptibility to infection and soft tissue complications. The Gustillo and Anderson classification describes the severity of these fractures based on contamination, size of the laceration, degree of soft tissue injury, and presence of vascular compromise. Open fractures are categorized as Grade I, II, or III with the degree of severity increasing in numerical order (I-III). Risk of infection and limb loss correlates with the Gustilo type. Antibiotic prophylaxis is an important adjunct in preventing infections in open lower extremity fractures, with broader coverage recommended in higher-severity fractures. Duration and choice of antibiotic therapy continue to be an ongoing area of clinical research that remains variable between institutions. Appropriate antibiotic prophylaxis regimen is controversial, and many trauma centers use broad-spectrum antibiotic therapies for coverage of Grade III fractures. There is substantial morbidity associated with commonly used broad-spectrum antibiotics in the open fracture population including antimicrobial resistance and potential AKI with aminoglycoside and glycopeptide use. Recent studies have shown that the implementation of an evidence-based antibiotic prophylaxis protocol for open fractures results in significantly decreased use of aminoglycoside and glycopeptide antibiotics without an increase in skin and soft tissue infection rates. The primary objective of this study is to examine infection rates before and after implementing an evidence-based antibiotic prophylaxis protocol for open fractures at our institution. Secondary objectives include assessing the number of dose drug administrations, cost differences and incidence of AKI before and after protocol implementation. The hypothesis of this study is that the infection rate after implementation of an evidence-based protocol would be non-inferior to a broad-spectrum protocol with decreases in dose drug administration, cost and incidence of AKI. Methods: This is single-center retrospective study which identifies patients who were admitted for open long fractures of lower extremities including femur and tibia/fibula fractures from 06/01/2014 through 06/01/2022. It includes all patients who were diagnosed with Type III open lower extremity fracture in age group 18+. A retrospective chart review will identify all adults (age 18+) with Grade III open femur and open tibia/fibula fractures and will be conducted by querying the institution trauma database and Epic Slicer Dicer. A preliminary list of patients who meet the criteria will be abstracted and compared based on respective antibiotic groups for presentation. Results and Conclusions Pending
https://digitalscholar.lsuhsc.edu/ortho_rd/2023/pres2/3