Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial

Document Type

Article

Publication Date

2-6-2025

Publication Title

Journal of Trauma and Acute Care Surgery

Abstract

BACKGROUND Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures. METHODS A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H, Mann-Whitney U, Pearson's χ(2), Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤ 24 hours, and > 24 hours) and facial fracture-associated infectious complications. RESULTS Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤ 24 hours, n = 264 (14.4%); > 24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤ 24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; > 24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668). CONCLUSION Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures.

First Page

557

Last Page

564

PubMed ID

39910705

Volume

98

Issue

4

Comments

This work was presented as a podium presentation at the 83rd Annual Meeting of American Association for the Surgery of Trauma on September 11–14, 2024 in Las Vegas, NV. See article for full author list.

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