Highlights
- •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%.
Abstract
Objective
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.
Methods
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.
Results
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).
Conclusion
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Air Medical JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in the management of open fractures: a critical analysis.J Bone Joint Surg Am. 2006; 88: 2739-2748
- Antimicrobial prophylaxis with combat-related open soft-tissue injuries.Mil Med. 2018; 183: e260-e265
- Prophylactic antibiotics in open fractures: a pilot randomized clinical safety study.J Orthop Trauma. 2013; 27: 552-557
- 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
- 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
- Infection and complications after low-velocity intra-articular gunshot injuries.J Orthop Trauma. 2017; 31: 330-333
- Prevention of infection in open fractures.Infect Dis Clin North Am. 2017; 31: 339-352
- Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection.J Orthop Trauma. 2015; 29: 1-6
- Low adherence to recommended guidelines for open fracture antibiotic prophylaxis.J Bone Joint Surg Am. 2021; 103: 609-617
- 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
- Decreased time to antibiotic prophylaxis for open fractures at a level one trauma center.J Orthop Trauma. 2017; 31: 596-599
- American College of Surgeons Trauma Quality Improvement Program.Best Practices in The Management of Orthopaedic Trauma. 2015; (Available at:) (Accessed February 25, 2022)
- Helicopter emergency medical services crew administration of antibiotics for open fractures.Air Med J. 2013; 32: 74-79
- Pediatric prehospital wound prophylaxis in Iraq and Afghanistan.Mil Med. 2020; 185: 73-76
- Prehospital antibiotic prophylaxis for open fractures: practicality and safety.Prehosp Emerg Care. 2019; 23: 385-388
- 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
- A fatal adverse effect of cefazolin administration: severe brain edema in a patient with multiple meningiomas.Drug Healthc Patient Saf. 2016; 2016: 9-12
- Emergency physician awareness of prehospital procedures and medications.West J Emerg Med. 2014; 15: 504-510
- Information loss in emergency medical services handover of trauma patients.Prehosp Emerg Care. 2009; 13: 280-285
- Assessing clinical handover between paramedics and the trauma team.Injury. 2010; 41: 460-464
- 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
- Prospective study of clostridium difficile intestinal colonization and disease following single-dose antibiotic prophylaxis in surgery.Antimicrob Agents Chemother. 1991; 35: 208-210
Article Info
Publication History
Published online: July 08, 2022
Identification
Copyright
© 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
