Antibiotic prophylaxis in the management of complex midface and frontal sinus trauma.
Summary of "Antibiotic prophylaxis in the management of complex midface and frontal sinus trauma."
OBJECTIVES/
HYPOTHESIS:
: Although mandible trauma has been studied extensively, there is no standard for use of pre- and postoperative antibiotics in other facial trauma. We sought to determine whether antibiotic strategies have an effect on infection rates. STUDY
DESIGN:
: Retrospective chart review and cohort analysis.
METHODS:
: Patients seen by the otolaryngology service for traumatic facial injuries between January 1, 2003 and January 1, 2009, were included in a retrospective cohort analysis (N = 223). All patients received perioperative antibiotic coverage. Isolated mandible fractures were excluded.
RESULTS:
: Patient demographics were 73% male and 27% female, with an average age of 35 years (range, 8-81 years). The most common causes of trauma were assault (39%), motor vehicle accidents (28%), and falls (11%). The overall infection rate was 9%. There was no significant difference (P = .248) between infection rates for patients in each antibiotic group (preoperative, postoperative, pre- and postoperative, only perioperative). Infection rate was independently correlated with both number of fractures (P < .0001) and open fracture wounds (P = .034). There was no significant difference in infection rate between patients who received only perioperative antibiotics and those who received additional antibiotics (P = .997). However, the cohort with the most antibiotic use (pre-, peri-, and postoperative) had more severe facial injuries than the cohort that received only perioperative antibiotics.
CONCLUSIONS:
: The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such antibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds. Laryngoscope, 2010.
Affiliation
Boston University School of Medicine, U.S.A.
Journal Details
This article was published in the following journal.
Name: The Laryngoscope
ISSN: 1531-4995
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20824781
- DOI: http://dx.doi.org/10.1002/lary.21081
Medical and Biotech [MESH] Definitions
Empyema, Subdural
An intracranial or rarely intraspinal suppurative process invading the space between the inner surface of the DURA MATER and the outer surface of the ARACHNOID. Bacteria and other pathogenic organisms may gain entrance to the subdural space from the FRONTAL SINUS; ETHMOID SINUS; middle ear (EAR, MIDDLE); MASTOID; or as the result of CRANIOCEREBRAL TRAUMA or NEUROSURGICAL PROCEDURES. This condition may be associated with intracranial sinus thrombosis (SINUS THROMBOSIS, INTRACRANIAL). Circumscribed collections of purulent material in the subdural space are referred to as subdural abscesses. (From Adams et al., Principles of Neurology, 6th ed, p709)
Paranasal Sinuses
Air-filled spaces located within the bones around the NASAL CAVITY. They are extensions of the nasal cavity and lined by the ciliated NASAL MUCOSA. Each sinus is named for the cranial bone in which it is located, such as the ETHMOID SINUS; the FRONTAL SINUS; the MAXILLARY SINUS; and the SPHENOID SINUS.
Frontal Sinus
One of the paired, but seldom symmetrical, air spaces located between the inner and outer compact layers of the FRONTAL BONE in the forehead.
Frontal Sinusitis
Inflammation of the NASAL MUCOSA in the FRONTAL SINUS. In many cases, it is caused by an infection of the bacteria STREPTOCOCCUS PNEUMONIAE or HAEMOPHILUS INFLUENZAE.
Lateral Sinus Thrombosis
Formation or presence of a blood clot (THROMBUS) in the LATERAL SINUSES. This condition is often associated with ear infections (OTITIS MEDIA or MASTOIDITIS) without antibiotic treatment. In developed nations, lateral sinus thrombosis can result from CRANIOCEREBRAL TRAUMA; BRAIN NEOPLASMS; NEUROSURGICAL PROCEDURES; THROMBOPHILIA; and other conditions. Clinical features include HEADACHE; VERTIGO; and increased intracranial pressure.
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