Multidisciplinary Facial Fracture Antibiotic Prophylaxis Guideline Failed to Reduce Antibiotic Recommendations or Administration

Authors:
Chris Guidry, Clint Humphrey, Duncan Nickerson, Jennifer Doan, John Flynn, Lauren Kerivan, Matt Shoemaker, Rahel Eshete, Robert Winfield, Robinson Okolo, Stepheny Berry, Terra Hill, Tien Pham

Body of Abstract:
Introduction
Despite evidence and guidelines recommending against prophylactic antibiotics for patients with facial fractures, their use remains widespread. To combat this issue, we created a multidisciplinary practice management guideline (PMG) recommending against the use of prophylactic antibiotics for these patients. This study evaluates the impact of the PMG on the rate of antibiotic recommendation and administration.

Methods
We conducted a retrospective review of electronic medical records of adult patients admitted to our Level 1 trauma center with a facial fracture secondary to traumatic mechanism between May 2022 to May 2024. The PMG was initiated on May 1, 2023. Patients were divided into pre- and post-implementation groups. Chi-square and Wilcoxon two-sample analyses were conducted to compare rates of antibiotic administration pre- and post-implementation.

Results
A total of 501 patients with a traumatic facial fracture were identified, of which 49.3% were during the pre-implementation and 50.7% within the post-implementation timeframes. Patients were primarily non-Hispanic (92%), White (70.7%), male (71.3%), and had a median age of 47 years. Maxillofacial infections were present in 0.4% of patients for both timeframes (p=0.98). There were no differences in either antibiotic recommendation or administration rates from pre- to post-PMG implementation of 29% to 34.5% (p=0.18) and 33.7% to 41% (p=0.09), respectively.

Conclusion
The creation of a multidisciplinary PMG failed to reduce prophylactic antibiotic administration for traumatic facial fractures. Antibiotic administration did not impact rates of maxillofacial infections between the two groups. Further investigations into the perceptions of antibiotic use in traumatic facial fractures is necessary to assess barriers to implementation of this PMG as well as to improve antibiotic stewardship.