SLR - November 2022 - Aaron Medina, DPM
Title: Efficacy of Cefazolin versus Ceftriaxone for Extremity Open Fracture Management at a Level 1 Trauma CenterReference: Salomon B, Griffard J, Patel J, Wideman M, Mcgee T, Corbitt N, Rowe AS, Price
C, Heidel R, McKnight CL. Efficacy of Cefazolin versus Ceftriaxone for Extremity Open Fracture
Management at a Level 1 Trauma Center. Surg Infect (Larchmt). 2022 Sep;23(7):675-681.
Reviewed By: Aaron Medina, DPM
Residency Program: Kaiser San Francisco Bay Area Foot and Ankle Residency Program,
Oakland California
Podiatric Relevance: Open fractures are quite common in the lower extremity, specifically in the foot and ankle given relative lack of overlying soft tissue coverage and increased propensity for osseous extrusion. First generation cephalosporins have become the mainstay for initial antibiotic therapy, although they have inherent drawbacks including narrow antibiotic spectrum and multiple doses, which may be missed. Ceftriaxone offers a broader antimicrobial coverage with decreased frequency of administration, typically dosing every 24 hours. The objective of this study was to evaluate the efficacy of cefazolin versus ceftriaxone in the management of open fractures.
Methods: This is a retrospective study involving 619 patients from 2015 to 2019 who sustained an open fracture. Patients were analyzed in two major groups: Cefazolin vs Ceftriaxone. Major outcomes were nonunion/malunion, surgical site infection deep or superficial,osteomyelitis, re-operation rate, limb loss, and death. Furthermore, they were analyzed in reference to Gustillo-Anderson grade.
Results: In regard to the above-mentioned outcomes, there was no statistical significant
difference between any of the groups. In regard to the sub group analysis (what is the sub group analysis?) there was no statistical significant difference. A multivariable analysis was performed suggesting that as the Gustilo-Anderson grade increases so does the rate of sequela from infection.
Conclusion: Ceftriaxone is a safe alternative to first generation cephalosporins with the added benefit of one-time 24-hour dosing with an increased microbial coverage. This study shows that whether ceftriaxone or cefazolin is used there is no statistically significant difference in infectious outcomes following open fractures.