DUPLICATE SUBMISSION – DO NOT SCORE**Assessing the Gap: SIS Guidelines vs. Real-World Antibiotic Use in Facial Fractures

Authors:
Ahmad El Nouiri, Hadi Hamdan, Jeffrey Johnson

Body of Abstract:
Introduction:
Facial fractures account for over 400,000 ED visits annually in the United States. They are managed operatively (open reduction and internal fixation, ORIF), non-operatively (closed reduction), or via observation with diet and activity modification. Regardless of management, antibiotics are commonly prescribed. The Surgical Infection Society (SIS) published 2020 guidelines advocating against antibiotic use in all pre- and post-operative as well as non-operative cases (upper face, mid-face, or mandibular).

Methodology:
This retrospective chart review evaluates antibiotic prescribing practices at a quaternary regional academic level one trauma center for patients with isolated facial fractures. It assesses potential antibiotic days saved by adhering to SIS guidelines. Data for all admitted patients above 18 presenting to Henry Ford Hospital’s trauma service with a facial fracture from January 2019 to August 2024 were acquired from the trauma registry. Patients were manually screened to ensure eligibility. Patients with clear antibiotic indications (e.g., open fractures, complex lacerations) were excluded. Antibiotic timing classification followed SIS guidelines: pre-op (>1 hour before surgery), peri-op (within 1 hour before surgery to 24 hours after), and post-op (>24 hours after surgery). Statistical analysis included descriptive methods for quantitative variables and Chi-Square for qualitative variables.

Results:
A total of 119 patients fit the criteria. 89.1% received antibiotics, with 57.6% receiving at least two. 80.2% of the antibiotics given were against the recommendations of the SIS. Total antibiotic days were 584. Mandibular (49.6%) and midface (41.2%) fractures were most common. The antibiotic administration rate for mandibular fractures was 98.3%. Operative management accounted for 93.2% of cases, mostly open. Antibiotic use did not significantly differ between operative and non-operative management (p=0.18). The rate of antibiotic use between open and closed operative management did not differ significantly either (p=0.99). Cephalosporins and Penicillins were most prescribed. Peri-op antibiotics were used in 89.9% of cases, but non-guideline operative use (pre and post-op) rates were 47.5% and 63.6%, respectively. No significant association existed between guideline publishing and non-guideline use (p=0.60). Surgical site infection and Clostridium Difficile complication rates were 0%.

Conclusion:
There is a clear discordance between antibiotic prescribing practices at our institution and the SIS guideline recommendations for facial fractures. Implementing guidelines could yield substantial cost savings and is vital in combating antibiotic resistance.