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Year : 2019  |  Volume : 9  |  Issue : 3  |  Page : 127-131

Cefazolin and an aminoglycoside compared with cefazolin alone for the antimicrobial prophylaxis of type iii open orthopedic fractures

1 Department of Pharmacy, St. Luke's University Health Network, PA, USA
2 Department of Pharmacy, Good Samaritan Hospital, San Jose, CA, USA
3 Department of Medicine, Section of Infectious Diseases, St. Luke's University Health Network, Bethlehem, PA, USA

Correspondence Address:
Dr. Shawn C Depcinski
St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_7_19

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Context: Uncertainty of antibiotic prophylaxis of type III open orthopedic fractures still exists. Controversy remains as using cefazolin as a single agent or the addition of an aminoglycoside for broader coverage to prevent infection. Aims: The aim of the study was to determine if the combination of cefazolin and an aminoglycoside reduced infections compared with cefazolin alone. Subjects and Methods: This was a retrospective study inclusive of patients with type III open fracture admitted between January 1, 2010, and August 31, 2014 at a level 1 trauma center, who were prophylactically treated with cefazolin alone or cefazolin and an aminoglycoside. Statistical Analysis Used: All analyses were performed using Microsoft Excel 2010. Chi-square or Fisher's exact tests were used for categorical data and Wilcoxon rank-sum test for skewed continuous data. Logistic regression analysis was performed on all confounding variables with P < 0.1. Results: A significantly higher percentage in the combination group developed infection (6/15 [40%] vs. 8/53 [15.1%], P= 0.035). There was a trend toward a higher odds of infection in the combination group (odds ratio: 2.99, 95% confidence interval: 0.79–11.33, P= 0.107). Infection rates due to multidrug-resistant bacteria were statistically higher with the combination group (3/15 [20%] vs. 1/53 [1.9%], P= 0.046). There were no statistically significant differences in 30-day mortality, 1-year readmission rates due to fracture complication, or length of hospital stay. Conclusions: The results suggest that the addition of an aminoglycoside to cefazolin may not be necessary to prevent infection.

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