Prehospital Administration of Cefazolin in Trauma Patients


      • Prehospital cefazolin was not associated with anaphylactic reactions.
      • The inappropriate administration rate for prehospital cefazolin was low.
      • The overall open fracture and deep wound infection rate after prehospital cefazolin was 6%.



      A lack of research has become a barrier to the common use of prehospital antibiotics. The objective of this study is to further the limited research of prehospital antibiotics through evaluating the clinical impact, safety, and reliability of prehospital cefazolin administration in trauma patients.


      We completed a retrospective evaluation of adult trauma patients who were transported by a single air and ground critical care transport program between January 1, 2014, and June 30 2017. Two hundred eighty-two patients received prehospital cefazolin for deep wounds or open fractures before their arrival at a single level 2 trauma center during the study period. Patient demographics, mechanism of injury, injury type, infection rate, and identification of allergic reactions to cefazolin were also collected.


      Of 278 patients in the final analysis, 35.3% (n = 98) were diagnosed with an open fracture and 58.6% (n = 163) had a deep tissue injury. Eighty-two percent of prehospital open fracture diagnoses were confirmed in the emergency department. The overall infection rate was 6%; 31.3% of patients received a second dose of cefazolin in the emergency department during the study period. No patients receiving prehospital cefazolin had allergic or anaphylactic reactions. The overadministration rate was 5% (n = 14).


      Prehospital providers reliably identified open fractures, and prehospital cefazolin administration was not associated with anaphylactic reactions. This study population's infection rate of open fractures caused by traumatic injury was found to be 6%, and there was a low inappropriate administration rate.
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        • Okike K
        • Bhattacharyya T.
        Trends in the management of open fractures: a critical analysis.
        J Bone Joint Surg Am. 2006; 88: 2739-2748
        • Lloyd BA
        • Murray CK
        • Shaikh F
        • et al.
        Antimicrobial prophylaxis with combat-related open soft-tissue injuries.
        Mil Med. 2018; 183: e260-e265
        • Saveli CC
        • Morgan SJ
        • Belknap RW
        • et al.
        Prophylactic antibiotics in open fractures: a pilot randomized clinical safety study.
        J Orthop Trauma. 2013; 27: 552-557
        • Rodriguez L
        • Jung HS
        • Goulet JA
        • Cicalo A
        • Machado-Aranda DA
        • Napolitano LM.
        Evidence-based protocol for prophylactic antibiotics in open fractures: improved antibiotic stewardship with no increase in infection rates.
        J Trauma Acute Care Surg. 2014; 77: 400-408
        • Redfern J
        • Wasilko SM
        • Groth ME
        • McMillian WD
        • Bartlett CS.
        Surgical site infections in patients with type 3 open fractures: comparing antibiotic prophylaxis with cefazolin plus gentamicin versus piperacillin/tazobactam.
        J Orthop Trauma. 2016; 30: 415-419
        • Nguyen MP
        • Reich MS
        • O'Donnell JA
        • et al.
        Infection and complications after low-velocity intra-articular gunshot injuries.
        J Orthop Trauma. 2017; 31: 330-333
        • Zalavras CG.
        Prevention of infection in open fractures.
        Infect Dis Clin North Am. 2017; 31: 339-352
        • Lack WD
        • Karunakar MA
        • Angerame MR
        • et al.
        Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection.
        J Orthop Trauma. 2015; 29: 1-6
        • Lin CA
        • O'Hara NN
        • Sprague S
        • et al.
        Low adherence to recommended guidelines for open fracture antibiotic prophylaxis.
        J Bone Joint Surg Am. 2021; 103: 609-617
        • Goodman AD
        • Modest JM
        • Johnson JP
        • Hayda RA.
        A simple initiative to decrease time to antibiotic prophylaxis for open fractures is durable after 2 years.
        J Am Acad Orthop Surg. 2021; 29: e932-e939
        • Johnson JP
        • Goodman AD
        • Haag AM
        • Hayda RA.
        Decreased time to antibiotic prophylaxis for open fractures at a level one trauma center.
        J Orthop Trauma. 2017; 31: 596-599
        • Committee on Trauma
        American College of Surgeons Trauma Quality Improvement Program.
        Best Practices in The Management of Orthopaedic Trauma. 2015; (Available at:) (Accessed February 25, 2022)
        • Thomas SH
        • Arthur AO
        • Howard Z
        • Shear ML
        • Kadzielski JL
        • Vrahas MS.
        Helicopter emergency medical services crew administration of antibiotics for open fractures.
        Air Med J. 2013; 32: 74-79
        • Naylor JF
        • April MD
        • Hill GJ
        • Schauer SG.
        Pediatric prehospital wound prophylaxis in Iraq and Afghanistan.
        Mil Med. 2020; 185: 73-76
        • Lack W
        • Seymour R
        • Bickers A
        • Studnek J
        • Karunakar M.
        Prehospital antibiotic prophylaxis for open fractures: practicality and safety.
        Prehosp Emerg Care. 2019; 23: 385-388
        • Haslam S
        • Yen D
        • Dvirnik N
        • Engen D.
        Cefazolin use in patients who report a non-IgE mediated penicillin allergy: a retrospective look at adverse reactions in arthroplasty.
        Iowa Orthop J. 2012; 32: 100-103
        • Sathitkarnmanee T
        • Tribuddharat S
        • Theerapongpakdee S
        • Ngamsangsirisup K
        • Chantawong S
        • Kitkhuandee A.
        A fatal adverse effect of cefazolin administration: severe brain edema in a patient with multiple meningiomas.
        Drug Healthc Patient Saf. 2016; 2016: 9-12
        • Waldron R
        • Sixsmith D.
        Emergency physician awareness of prehospital procedures and medications.
        West J Emerg Med. 2014; 15: 504-510
        • Carter AJE
        • Davis KA
        • Evans LV
        • Cone DC.
        Information loss in emergency medical services handover of trauma patients.
        Prehosp Emerg Care. 2009; 13: 280-285
        • Evans SM
        • Murray A
        • Patrick I
        • et al.
        Assessing clinical handover between paramedics and the trauma team.
        Injury. 2010; 41: 460-464
        • Maddry JK
        • Simon EM
        • Reeves LK
        • et al.
        Impact of a standardized patient hand-off tool on communication between emergency medical services personnel and emergency department staff.
        Prehosp Emerg Care. 2021; 25: 530-538
        • Privitera G
        • Scarpellini P
        • Ortisi G
        • Nicastro G
        • Nicolin R
        • de Lalla F.
        Prospective study of clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery.
        Antimicrob Agents Chemother. 1991; 35: 208-210