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. 2025 Apr 16:10.1097/BOT.0000000000002996.
doi: 10.1097/BOT.0000000000002996. Online ahead of print.

Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia Fractures

David Okhuereigbe  1 , Michael Raffetto, Vivian Li, Alice Bell, Joshua E Lawrence, Joanna Kim, Christina A Stennett, Gerard P Slobogean, Nathan N O'Hara, Robert V O'Toole
Affiliations

Association Between Timing of Antibiotics and Deep Surgical Site Infection in Gustilo-Anderson Type III Open Tibia Fractures

David Okhuereigbe et al. J Orthop Trauma. .

Abstract

Objectives: To determine the association between the timing of antibiotic delivery in the emergency department (ED) and deep surgical site infection in Gustilo-Anderson (GA) type III open tibia fractures.

Methods: Design: Retrospective cohort study.

Setting: Single Level I Trauma Center.

Patient selection criteria: Patients aged ≥18 years with a Gustilo-Anderson (GA) type III open tibia fracture (OTA/AO 41, 42, or 43) from 2016 to 2021 were included.

Outcome measures and comparisons: The outcome was deep surgical site infection requiring irrigation and debridement. The effect of time of delivery of antibiotics was compared in 3 analyses: as a continuous variable, before vs after 60 minutes, and before vs after 180 minutes. The study analysis accounted for known confounders for infection, including Injury Severity Score (ISS), GA classification, and wound contamination.

Results: The study population included 191 patients with a mean age of 44 years (SD: 17) and 153 males. The median time from arrival to the first antibiotic was 44 minutes (IQR: 21-147). The majority of patients (99.0%) received cephazolin as their initial antibiotic. The overall 90-day risk of deep surgical site infection requiring irrigation and debridement was 10.5%. The timing of antibiotic administration as a continuous variable was not associated with infection (aOR: 1.00, 95% CI: 0.99-1.00, P = 0.39). Similarly, time to antibiotic administration was not associated with infection at thresholds of 1 hour (aOR: 1.02, 95% CI: 0.39-2.68, P = 0.96) or 3 hours (aOR: 1.08, 95% CI: 0.35-3.37, P = 0.89) in separate models.

Conclusions: Early antibiotic administration was not associated with a reduced risk of deep surgical site infection in GA type III tibia fractures. These results suggest that the acute timing of antibiotics may not be as impactful to patients' risk of infection as once considered.

Level of evidence: Therapeutic, Level III.

Keywords: Gustilo-Anderson; antibiotic; fracture; infection; open; tibia.

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Conflict of interest statement

Conflict of Interest: G. P. Slobogean is a paid consultant for Smith & Nephew and Zimmer, unrelated to this work. N. N. O’Hara receives stock or stock options from Arbutus Medical Inc., unrelated to this work. R. V. O’Toole is a paid consultant for Stryker, receives stock or stock options from Imagen, and receives royalties from Lincotek, all unrelated to this work. The remaining authors report no conflicts.

Figures

Figure 1.
Figure 1.
CONSORT diagram.
Figure 2.
Figure 2.
Time from arrival to antibiotics. The median time of antibiotic administration was 44 minutes (IQR: 21–147, N=191). Note that datapoints in the top 5th percentile were omitted in this figure for readability.
See this image and copyright information in PMC

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