1756: assessment of prophylactic antibiotic guideline compliance in culture-positive open fractures
Abstract
Learning Objectives: Prophylactic antibiotics are recommended in patients with open fractures. Gram-positive coverage is standard of care, and broader gram-negative coverage is recommended for Gustilo-Anderson (GA) type III fractures. This study evaluated the coverage of an institutional prophylactic antibiotic guideline in culture positive-open fracture infections. Methods: This Institutional Review Board-approved, retrospective, observational study included adult patients admitted to an academic Level I Trauma Center between Jan 2015 and May 2017 with at least one open fracture and an associated positive culture. Wound isolates and susceptibilities were recorded. The primary outcome was to determine the percentage of patients whose isolates were classified as antibiotic prophylaxis protocol-covered (PC) or not-covered (NC) based on our institutional guideline. Our guideline recommends 24 hours of cefazolin for GA type I or II fractures and vancomycin plus either ceftriaxone or levofloxacin for type III fractures. Secondary outcomes include the time to culture, number of multidrug resistant (MDR) isolates, and hospital length of stay between the PC and NC groups. Results: Of 957 patients identified with one or more open fractures, 75 patients with positive cultures were included for final analysis with 121 distinct isolates. 72% of included patients had type III fractures. The most common pathogens were Staphylococcus aureus (n=31) and Enterobacter cloacae (n=21). 53% of…
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