Compliance with the Eastern Association for the Surgery of Trauma guidelines for prophylactic antibiotics after open extremity fracture
Cassie A Barton1, Wesley D McMillian2, Bruce A Crookes3, Turner Osler4, Craig S Bartlett5
1 Department of Pharmacy, Fletcher Allen Health Care, Burlington, VT, USA
2 Department of Pharmacy, Fletcher Allen Health Care; Department of Surgery, University of Vermont, Burlington, VT, USA
3 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
4 Department of Surgery, University of Vermont, Burlington, VT, USA
5 Department of Orthopedics, University of Vermont, Burlington, VT 05401, USA
Cassie A Barton
Department of Pharmacy, Fletcher Allen Health Care, 111 Colchester Avenue, Mailstop 272BA1, Burlington, VT 05401
Source of Support: None, Conflict of Interest: None
Context: Prophylactic antibiotics, paired with wound care and surgical intervention, is considered the standard of care for patients with open fracture. Guidelines from the Eastern Association for the Surgery of Trauma (EAST) recommend specific prophylactic antimicrobial therapy based on the type of open fracture.
Aims: We quantified adherence to EAST guideline recommendations and documented the incidence of infection in patients with open fracture.
Settings and Design: A retrospective, observational study of all patients with open fracture admitted to our facility from January 2004 to December 2008 was conducted.
Materials and Methods: Patients were divided into compliant and noncompliant groups according to the EAST guideline recommendations. Compliance was defined as an appropriate spectrum of therapy for guideline suggested duration. We assessed for surgical and non-surgical site infections, and morbidity outcomes.
Statistical Analysis: Nominal data were explored using summary measures. Continuous variables were compared using the Student t-test or the Mann-Whitney U-test. Dichotomous data were compared using χ2 statistic or Fisher's exact test.
Results: The final analysis included 214 patients. Prophylactic antibiotics were guideline compliant in 28.5% of patients, and ranged from 10.0% in type 3b fractures to 52.7% in type 1 fractures. The most common reason for non-compliance was the use of guideline recommended coverage that exceeded the suggested duration (71.2%). Patients who received non-compliant therapy required prolonged hospital lengths of stay (6 vs. 3 days, P = 0.0001). The overall incidence of infection was similar regardless of guideline compliance (17.0% vs. 11.5%, P = 0.313).
Conclusions: Prophylactic antibiotics for open fracture frequently exceeded guideline recommendations in duration and spectrum of coverage, especially in more severe fracture types. Non-compliance with EAST recommendations was associated with increased in-hospital morbidity.