Methods: Hospitalized adults with OF from 12/2011-12/2012 at a Level 1 Trauma Center in Columbia, SC, were identified. In vitro antimicrobial susceptibility of pathogens causing OM to currently recommended prophylactic cefazolin(cef) plus gentamicin (gent) for high-grade OF was compared to other potential prophylactic regimens.
Results: A total of 174 patients with OF were included, including 46 who developed subsequent OM. The majority were non-white (54%), males (71%), with OF in the lower extremities (78%). Individuals who developed OM were more likely to have a IIIB OF (43% vs 13%, p=<0.001) with visible contamination (43% vs 17%, p<0.001). The incidence proportion of developing OM with low grade (≤ II) fractures was 0.13 (13/97) and that for high grade (≥III) OF was 0.43 (33/77).
The majority of patients (44/46) received cef at time of initial injury and 28/33 with high grade OF received additional GN coverage (22 gent, 2 piperacillin/tazobactam, 2 aztreonam, 1 ceftazadime and 1 ciprofloxacin).
Overall gram negative bacilli were the most common causative organisms of OM after high grade OF (27/41 isolates) including 10 potential chromosomally-mediated AmpC-producing Enterobacteriaceae (6 Enterobacter spp and 4 Serratia spp) and 6 Pseudomonas aeruginosa isolates. The remaining pathogens included 14 gram positive organisms (4 methicillin-resistant staphylococci, 6 methicillin-susceptible staphylococci, 3 Enterococcus spp and 1 bacillus spp) and 1 Candida albicans.
74% of these organisms were susceptible to current antibiotic prophylaxis regimen, gent and cef. Cefepime, piperacillin/tazobactam and ciprofloxacin would provide coverage for 77%, 74 % and 84% of OM organisms, respectively. Addition of vancomycin would provide additional GP coverage particularly methicillin-resistant staphylococci.
Conclusion: Based on the above results, a powerplan was formulated using ciprofloxacin and vancomycin in an attempt to minimize the risk of OF-associated OM and limit unnecessary broad-spectrum beta-lactams.
S. Weissman, None
H. Albrecht, Gilead: Investigator and Scientific Advisor , Research grant
R. Berdel, None
S. Albrecht, None
M. Iyer, None
J. Horvath, None