Cefazolin Monotherapy Versus Cefazolin Plus Aminoglycoside for Antimicrobial Prophylaxis of Type III Open Fractures
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PublisherThe University of Arizona.
JournalAmerican Journal of Therapeutics
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: There are conflicting recommendations between organizations regarding aminoglycoside use for the prophylaxis of type III open fractures. Study Question: To compare cefazolin monotherapy versus cefazolin plus aminoglycoside therapy for prophylaxis of type III open fractures in trauma patients. Study Design: This was a multicenter retrospective cohort study conducted in three academic medical centers in the United States. Consecutive adult trauma patients with type III open fractures between January 2014 and September 2016 were included. Patients were divided into two groups: 1) cefazolin monotherapy versus 2) cefazolin plus aminoglycoside. Measures and Outcomes: The primary outcome measure was occurrence of infection at the open fracture site. The secondary outcome measure was occurrence of acute kidney injury. Results: There were 134 patients included in the study cohort. Of these, 39 received cefazolin monotherapy and 95 received cefazolin plus aminoglycoside. Overall, the mean age was 39 ± 15 years, 105 (78%) were male, and the most common fracture location was tibia/fibula (n=74, 56%). Infection at the open fracture site occurred in 6/39 (15%) in the cefazolin monotherapy group and 15/95 (16%) in the cefazolin plus aminoglycoside group (p=1.000). Acute kidney injury occurred in 0/39 (0%) in the cefazolin monotherapy group and 1/95 (1%) in the cefazolin plus aminoglycoside group (p=1.000). Conclusion: Cefazolin monotherapy may be appropriate for antimicrobial prophylaxis of type III open fractures in trauma patients.