Category: Fellows Posters
Purpose: New literature suggests that narrower antibiotic coverage may be appropriate in open long bone fractures. The current trauma admission antibiotic policy for open fracture at this Level 1 Trauma Center provides guidance to choose wider spectrum antibiotics in grade three open fractures. Unnecessary use of broad spectrum antibiotics in open fractures may lead to increased antibiotic resistance, impaired wound healing and acute kidney injury. The goal of this study is to promote antimicrobial stewardship through a retrospective chart review to evaluate current antibiotic prescribing patterns in open long bone fractures and assess the need to update current policy.
Methods: The current order set and policy for open long bone fractures at this Level 1 Trauma Center provides broad spectrum antibiotic options such as piperacillin-tazobactam, ciprofloxacin and meropenem. The current policy suggests treatment with antibiotics no longer than 72 hours unless an infection is proven, but no stop dates are automatically incorporated when antibiotics are ordered. The protocol is organized by three grades of fractures defined by the Eastern Association for the Surgery of Trauma. The primary outcome of this literature evaluation and chart review will be to identify the percentage of patients with long bone open fractures started on broad spectrum antibiotics. Secondary outcomes will include: antibiotic regimen chosen, duration of antibiotic coverage, and blood and wound culture results. This study will be submitted to the Institutional Review Board for approval. The electronic health record system will be searched to identify patients who have been initiated on the trauma admission order set and appropriate fracture diagnosis codes. The following data will be collected: patient age, gender, weight, allergies, fracture grade, antibiotic therapy, duration of antibiotic therapy, physical examination findings, blood culture results, wound culture results and renal function. Provider documentation will be reviewed to determine if the reason for broad spectrum antibiotic use is documented. All data will be recorded without patient identifiers to maintain confidentially.