title: Surgical Site Infections in Patients With Type 3 Open Fractures: Comparing Antibiotic Prophylaxis With Cefazolin Plus Gentamicin Versus Piperacillin/Tazobactam.
abstract: OBJECTIVE
  The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Seven hundred sixty-six patients admitted between January 1, 2004, and December 31, 2012, with open fractures were identified using the National Trauma Data Bank by searching International Classification of Diseases, Ninth Revision (ICD-9) codes. Electronic medical record review revealed 134 patients with type 3 open fractures, of which 72 were included in the final analysis.
  
  
  METHODS
  Administration of cefazolin plus gentamicin or piperacillin/tazobactam for type 3 open fracture antibiotic prophylaxis.
  
  
  METHODS
  SSI, nonunion, death, and rehospitalization rates at 1 year.
  
  
  RESULTS
  Surgical site infection at 1 year occurred in 12 of 37 patients (32.4%) in the cefazolin plus gentamicin group and 11 of 35 patients (31.4%) in the piperacillin/tazobactam group (P = 1.000). Nonunion, death, and rehospitalization rates at 1 year were similar between the 2 groups. Although there was no statistically significant difference in SSI at 30 days between groups, the rate was higher in the cefazolin plus gentamicin group (21.6% vs. 11.4%; P = 0.246).
  
  
  CONCLUSIONS
  At our institution, use of piperacillin/tazobactam as compared with cefazolin plus gentamicin for antibiotic prophylaxis in patients with type 3 open fractures showed similar rates of SSI, nonunion, mortality, and rehospitalization at 1 year after injury.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Pharmacy, University of Vermont Medical Center, Burlington, VT; and †Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Jenessa
authors.initials: J
authors.lastname: Redfern
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wasilko
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Groth
authors.forename: Wesley D
authors.initials: WD
authors.lastname: McMillian
authors.forename: Craig S
authors.initials: CS
authors.lastname: Bartlett
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D005597:Fractures, Open / Q000401:mortality* / Q000628:therapy*; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010878:Piperacillin / Q000008:administration & dosage; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D015996:Survival Rate; D000078142:Tazobactam; D016896:Treatment Outcome; D014707:Vermont / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins; D010397:Penicillanic Acid; D002437:Cefazolin; D000078142:Tazobactam; D010878:Piperacillin