Patterns and Predictors of Delayed Antibiotic Administration in Open Fracture Care at CHUK

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Patterns and Predictors of Delayed Antibiotic Administration in Open Fracture Care at CHUK

Authors:
Emile Musoni, Isabella Hung

Body of Abstract:
Background: Open fractures are among the most common cases received at emergency departments (ED) in low- and middle-income countries and early administration (within 60 minutes) of antibiotics is the cornerstone component in the management of open fractures. We aim to evaluate the risk factors associated with delays in time to antibiotics administration for patients with long bone open fractures at the University Teaching hospital of Kigali (CHUK) in Rwanda. 

Methods: This is a prospective study of all ages presenting to the emergency department of CHUK with an open long bone fracture. Those admitted from other health facilities or presented with infected wounds were excluded. Participants completed a structured questionnaire. Data were collected between December 2020 to April 2022 and analyzed using Stata version 13. Binary logistic regression was used to determine risk factors in >60 minutes antibiotic administration. 

Results: A total of 120 participants were recruited, the majority were males (N= 100, 83.3[MSD2] %). 99.17% (N= 99) of participants presented to the emergency department >1 hour after their accident. Additionally, 42.5% (N= 51) of participants received antibiotics within the first 60 minutes. Nightshift admissions had 6 times the odds of receiving antibiotics after 60 minutes as compared to dayshift (OR=6.0, 95% CI: 2.58-13.93, p<0.001). Patients without medical insurance had 8.5 times the odds of receiving antibiotics after 60 minutes as compared to those with health insurance (OR=8.5, 95% CI: 1.04-58.51, p=0.045) and children who presented at the emergency department with open fractures had 3.8 times the odds of receiving antibiotics after 60 minutes compared to adults (OR=3.8, 95% CI: 1.02-14.07, p=0.031).  Conclusion: Delays in antibiotic administration were widespread amongst patients presenting to CHUK with open long bone fractures. Patients particularly at risk included pediatric patients, patients without health insurance, and those presenting overnight. Furthermore, delays in presentation resulted in nearly all patients receiving antibiotics greater than 60 minutes from time of injury. Providing antibiotics in the prehospital setting may help reduce these delays. Additionally, targeted educational programs for providers may help prevent delays in antibiotic administration after arrival.

Leveraging Electronic Medical Records for Improved Performance in Surgical Site Infections

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Leveraging Electronic Medical Records for Improved Performance in Surgical Site Infections

Authors:
Drishti Lall, Yeshwanth Vedire, Abigail Ruby, Eman Chami, Anita Shallal, Arielle Hodari Gupta

Body of Abstract:
Background  

Surgical site infection (SSI) rates are reported by institutions and monitored by organizations such as the CDC National Healthcare Safety Network (NHSN) and Centers for Medicare and Medicaid Services (CMS). Accurate reporting of SSI requires distinguishing between infections present at time of surgery (PATOS) and those occurring in the post-operative period. Internal data for reported SSI rates for colon surgeries (COLO) at our institution revealed inaccurate reporting of SSI due to misclassification and absence of documentation for infections present at the time of surgery (PATOS). To combat these missed opportunities for accurate documentation, we leveraged the electronic medical record (EMR) in operative notes. This study evaluates rates of infection PATOS in COLO and the impact of the intervention on reported rates of SSI for COLO.    

Methods  

This was an IRB exempt descriptive study at our single tertiary care and level 1 trauma center in southeast Michigan. Beginning in 2022, a standardized EPIC SmartPhrase became available system wide which could be included in operative reports. This SmartPhrase included a drop down menu of descriptors that met criteria for appropriate classification of infection or contamination PATOS. Chart review was used to quantify infection PATOS and reported SSIs between 2020-2024 for COLO cases. The primary endpoint was the number of COLO PATOS cases per year.  Descriptive statistics was utilized. 

Results  

Following implementation of the PATOS initiative in 2022, reportable SSIs for COLO decreased from 18 cases in 2022 to 16 in 2023, and further to 11 in 2024 [Figure]. During this same period, documented PATOS cases rose from 9 in 2022 to 16 in 2024. Examples of non-standardized terminology used to describe infections PATOS in operative notes that do not utilizethe standardized dot phrase included “air fluid collection in pouch of Douglas,” and “dilated, malperfused colon.”  

Conclusion  

Implementation of a standardized PATOS SmartPhrase in colon surgery operative notes resulted in an increase in accurate documentation of infections PATOS, with a corresponding decrease in reportable SSIs for COLO at our institution. Continued implementation of the PATOS initiative to promote consistent use of the standardized SmartPhrase in all operative documentation could continue to improve accurate documentation of infections PATOS and potentially have a significant effect on reportable SSI rates.

Pediatric Surgical Patients with Sepsis at a National Referral Hospital in Uganda: Predominant Organisms and Antibiotic Resistance Patterns

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Pediatric Surgical Patients with Sepsis at a National Referral Hospital in Uganda: Predominant Organisms and Antibiotic Resistance Patterns

Authors:
Julia Harrison, Brian Kasagga, Grace Nambatya, Janet Maseka, Michael Semanda, Nasser Kakembo, Jennifer Rickard

Body of Abstract:
Background

Sepsis remains a leading cause of morbidity and mortality among children in low- and middle-income countries (LMICs), yet its burden in pediatric surgical patients is poorly characterized. Additionally, there is limited data describing causative organisms or antibiotic resistance patterns in pediatric surgical patients in LMICs. 

Methods

This analysis is part of a larger prospective observational study evaluating the etiology, diagnosis, management, and outcomes of sepsis among children on a pediatric surgery ward in Uganda. Patients with clinical criteria for sepsis are eligible for blood culture collection. A single sample is routinely obtained and processed using the BD BACTEC system in Peds Plus Aerobic bottles. In addition to culture data, demographic information, clinical diagnoses, antibiotic use, operative details, and patient outcomes are recorded.

Results

Of 82 patients enrolled to date, 42 blood culture results were available. Pathologies leading to sepsis were predominantly intra-abdominal (67%), followed by urinary tract (10%), pulmonary (7%), and skin/soft tissue infection (6%), with 10% of patients having an unknown source. The median age at culture collection was 11 days (IQR 6-21). 27 of 42 cultures (64%) were positive and all isolated bacteria were multidrug resistant. Klebsiella pneumoniae accounted for 12/27 (44%) positive cultures, followed by Staphylococcus species (5/27, 18.5%), and Candida species (5/27, 18.5%). All patients were on antibiotics, while none were on antifungals, at the time of culture collection. Based on culture results, 1 of 27 (3.7%) patients was adequately covered by antimicrobials, 20/27 (74.1%) were not adequately covered, and adequate coverage was unable to be determined in 6/27 (22.2%) patients. Klebsiella pneumoniae isolates showed high rates of resistance across 10 of 11 tested antibiotic classes (figure 1), while most (10/12 isolates, 83%) retained sensitivity to carbapenems. In-hospital mortality among all enrolled was 58%. Mortality among those with positive cultures was 60%, with 73% mortality among those with Klebsiella bacteremia. 

Conclusions

These findings demonstrate a substantial burden of culture-positive sepsis among pediatric surgical patients in Uganda. There was a predominance of intra-abdominal, followed by urinary tract pathology and most patients were extremely young at presentation. All isolated bacteria demonstrated multidrug resistance and almost all isolated bacteria were resistant to empirically used antibiotics. Empiric antifungal coverage, while not currently in practice, appears to be needed. Klebsiella pneumoniae was the leading pathogen isolated and exhibited extensive multidrug resistance. The high overall mortality highlights the severity of sepsis in this population and underscores the urgent need for strengthened infection prevention, earlier recognition of sepsis, local antibiograms, and improved access to effective antibiotics and antifungals.

Longer Durations of Intravenous Antibiotics are Not Protective for Pediatric Complicated Appendicitis Treated According to a Pragmatic Standardized Protocol

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Longer Durations of Intravenous Antibiotics are Not Protective for Pediatric Complicated Appendicitis Treated According to a Pragmatic Standardized Protocol

Authors:
Jeannette Joly, Krysta Sutyak, Erin Morris, Terry Fisher, Erich Grethel, Monica Lopez, KuoJen Tsao, Kevin Lally

Body of Abstract:
Background: The Pediatric Surgery Quality Collaborative (PSQC) conducted a pilot study wherein 21 hospitals adopted an evidence-based, short-course antibiotic protocol (4+/-1 total days) for postoperative pediatric complicated appendicitis. The pragmatic protocol allowed intravenous (IV) antibiotic duration to be at the discretion of the prescriber. This study aims to evaluate the impact of IV antibiotic duration on patient outcomes specifically in those treated with short-course antibiotics.

Methods: A retrospective review was conducted of PSQC protocol-adopting hospitals (07/2023-06/2025). De-identified hospital data were obtained in quartiles from the National Surgical Quality Improvement Program-Pediatric procedure-targeted and custom variable fields. Pediatric complicated appendicitis patients were included if they received postoperative short-course antibiotics: a total of 5 days or fewer. Univariate and multi-level multivariate analyses, and Spearman’s correlation coefficient (ρ) were utilized.

Results: Across 21 adopter hospitals, 1421 patients were treated with short-course antibiotics. Patients were median age 10.2 years (IQR: 7.3-13.3) and 58% male. Overall, the median total antibiotic duration was 4.0 days (IQR: 3.0-5.0), IV antibiotic duration was 3.0 days (IQR: 2.0-4.0), and hospital length of stay (LOS) was 3.0 days (IQR: 2.0-4.0). Rate of organ space surgical site infection (OS-SSI) was 5.6% overall, but varied by duration of IV antibiotics: 2.5% for 0 days, 1.5% for 1 day, 2.3% for 2 days, 5.7% for 3 days, 7.1% for 4 days, and 9.6% for 5 days. After controlling for gender, body mass index, sepsis grade, anesthesia class, procedure duration, and intraoperative visible findings, each additional day of IV antibiotics was associated with an absolute increase in predicted probability of developing an OS-SSI by 1.9% (95% CI: 0.7-3.2; p<0.01) (FIGURE), of having at least one emergency department (ED) visit by 3.7% (95% CI: 2.0-5.4; p<0.01), and of having at least one hospital readmission by 2.2% (95% CI: 0.9-3.5; p<0.01). A strong, positive correlation was detected between total IV antibiotic days and hospital LOS (ρ: 0.73; p<0.01), with median hospital LOS of 1 day (IQR: 1-3) for those with 0 IV antibiotic days, up to 5 days (IQR: 5-6) for those 5 days of IV antibiotics. Conclusion: Durations of IV antibiotics are highly variable in patients who receive short-course antibiotics according to a standardized pragmatic protocol, with longer durations not necessarily protective against subsequent SSIs, ED visits, or readmissions. This suggests that certain patients may be more likely to develop infection and/or have increased healthcare utilization regardless of IV antibiotic durations. Additionally, since IV antibiotic duration is directly correlated with hospital LOS, it may follow that fewer IV antibiotic days leads to shorten hospital stays without specifically increasing infection risk or healthcare utilization.

Loss of Independence following Necrotizing Soft Tissue Infections in Older Adults

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Loss of Independence following Necrotizing Soft Tissue Infections in Older Adults

Authors:
Manuel Castillo-Angeles, Avery Thompson, Reza Askari

Body of Abstract:
Background: There is a growing shift in benchmarking for older adult care toward metrics that capture outcomes of greatest importance to this cohort. Loss of independence (LOI), which is a composite outcome used to identify patients who are no longer able to live independently post-operatively, has been introduced as a key patient-centered outcome among older adults. However, this hasn’t been fully studied in the necrotizing soft tissue infections (NSTI) population. Our objective was to identify predictors of LOI among NSTI patients.

 

Methods: The American College of Surgeons National Surgical Quality Improvement Project database (2021-2023) was queried for older adults with a diagnosis of NSTI, which included necrotizing fasciitis, gas gangrene, and Fournier’s gangrene. Our primary outcome was LOI, defined as a decline in functional status, or an increase in care needs (patients discharged to a non-home destination or who needed new support or skilled services at home). Multivariable logistic regression was used to determine factors associated with LOI.

 

Results: We included 232 older adults with NSTI, mean age was 77.83 (SD 6.14) years, 39.22% were female, and 70.33% were White. 124 (53.45%) experience loss of independence. 

After adjusted analysis, significant predictors of LOI were age >=85 years (Odds Ratio [OR] 1.63, 95% Confidence Interval [CI] 1.60–2.09), frailty status (OR 11.17, 95%CI 5.65–16.57), history of dementia or cognitive impairment (OR 5.62, 95%CI 2.43–8.82), and postoperative length of stay (OR 1.21, 95%CI 1.01–1.45). 

 

Conclusions: More than half of older adults with a diagnosis of NSTI experienced loss of independence. LOI could be used as a marker to identify patients who require closer post-discharge monitoring. Further work should focus on targeted interventions that reduce the risk of postoperative LOI in this vulnerable population.

Microbial Signatures of Thrombosis and Organ Failure in Surgical ICU Patients

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Microbial Signatures of Thrombosis and Organ Failure in Surgical ICU Patients

Authors:
Ioannis Karikis, Yasmin Arda, Galit H. Frydman

Body of Abstract:
Background:
 Surgical ICU patients, exposed to severe physiological stress and broad-spectrum antimicrobials, may be vulnerable to pathogen-driven thrombosis and organ injury, but species-level data are limited. We aimed to determine whether specific species-level microbial patterns are enriched in SICU patients who develop major thrombosis and/or organ failure.

Methods:
 We conducted a single-center retrospective cohort study of 137 surgical ICU (SICU) patients with suspected infection and available culture and sensitivity data who underwent longitudinal microbiologic sampling during their SICU admission between 2020 and 2024. For each patient, we identified growth of bacterial and fungal species, including speciation and antibiotic sensitivity data, as well as concurrent viral infection, as clinically indicated. The primary outcome was a major thrombotic event (MTE) (deep venous thrombosis, pulmonary embolism, line thrombosis, myocardial infarction, or stroke). Secondary outcomes were acute kidney injury (AKI) and acute liver failure (ALF) during the index hospitalization. Associations between microbial patterns and outcomes were evaluated descriptively using χ² or Fisher’s exact tests, as appropriate.

Results:
Of 137 patients, 22 (16%) developed an MTE. Among 132 patients with available renal and liver data, 41 (31%) developed AKI and 10 (8%) developed ALF. Thrombosis was more common in patients with Candida and several bacterial pathogens. Any Candida species were present in 36% of patients with thrombosis versus 4% without (p<0.001), driven predominantly by non-albicans Candida. Thrombotic patients were also more likely to grow Enterococcus species (23% vs 6%, p=0.038), Escherichia coli (E. coli) (27% vs 5%, p=0.003), Staphylococcus aureus (S. aureus) (14% vs 2%, p=0.023), and showed a trend towards Pseudomonas species (18% vs 4%, p=0.052). AKI exhibited a similar microbial signature. Candida species were again enriched in patients with AKI (27% vs 2%, p<0.001), as were Klebsiella pneumoniae (K. pneumoniae) (17% vs 6%, p=0.032), Enterococcus species (20% vs 4%, p=0.005), and E. coli (17% vs 6%, p=0.032). AKI also clustered with COVID-19 infection (78% vs 48%, p=0.001). ALF was less frequent but showed signals for Enterococcus faecium (E. faecium) (30% vs 7%, p=0.017) and K. pneumoniae (20% vs 2%, p=0.001) in a small subgroup. Conclusions:  In this SICU cohort, MTE, AKI, and ALF each appeared to have distinct infectious-agent signatures. These findings support the hypothesis that specific pathogens may play a significant role in the development of thrombosis and multi-organ failure in critically ill patients. These exploratory data are hypothesis-generating and justify larger studies that integrate microbiology, coagulation, and organ-dysfunction endpoints in the SICU population.

Microbiology of Mesh Infections after Ventral Hernia Repair

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Microbiology of Mesh Infections after Ventral Hernia Repair

Authors:
Coleman Miller, Edwin George Mathew, Dalya Ferguson, Julie Holihan, Thomas Clements, Jonah Stulberg

Body of Abstract:
Background

More than 600,000 ventral hernia repairs are performed in the United States annually. While rare, mesh infection is a devastating complication for patients which can result in years of painful surgeries and recurring hospitalizations. Despite the significance of this problem, there is very little data regarding the current microbiology of mesh infections. Previous studies have suggested that methicillin-resistant staphylococcus aureus (MRSA) is responsible for more than 50% of mesh infections, however with changing mesh types and the increasing use of minimally invasive techniques, we sought to determine the current microbiology of mesh infections at our complex hernia center.

Methods

We utilized our IRB approved, hernia quality database that captures detailed pre-, intra- and post-operative data on 100% of hernia cases performed by our four dedicated hernia surgeons. All patients with a known mesh infection were included in this study. Patients were excluded if there were no cultures obtained at the time of surgery. We extracted demographic variables and operative details from our hernia registry and then used chart review to evaluate cultures from the time of surgery.

Results

Our database contains 662 unique patients who have undergone ventral hernia repair between August of 2021 and June of 2025. All 13 patients who came to our institution with a mesh infection and had cultures obtained at the time of surgery had Gram-Positive bacteria in their samples. Seven cultures (54%) resulted as Staphylococcus aureus, with a majority exhibiting methicillin resistance (MRSA) (31% of all samples). Seven cultures (54%) resulted as Enterococcus spp. with one culture demonstrating both Staphylococcus aureus and Enterococcus spp.. Seven patients had polymicrobial infections with Gram-negative and Gram-positive organisms. The most common Gram-negative organisms were Klebsiella spp. (4, 31%) and E. coli (4, 31%), with Proteus spp. (3, 23%) and Pseudomonas spp. (2, 15%).

Conclusion

There is very little published data regarding the rate of chronic mesh infection after ventral hernia repair or the bacteria responsible for these infections.  It is critical to understand the bacteria responsible if we hope to eliminate this adverse outcome. Our results demonstrate the diversity of bacteria involved in chronic mesh infections and therefore the diversity of sources of infection and highlight the need for further study in this area.

Microbiology, Antibiotic Resistance, and Antimicrobial Burden in Infected Necrotizing Pancreatitis: A Single-Center Cohort

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Microbiology, Antibiotic Resistance, and Antimicrobial Burden in Infected Necrotizing Pancreatitis: A Single-Center Cohort

Authors:
Ioannis Karikis, Jack H. A. Miller, Arielle M. Moore, Peter J. Fagenholz, Yasmin G. Hernandez-Barco, Miriam B. Barshak, Casey M. Luckhurst

Body of Abstract:
Background:
 Infected necrotizing pancreatitis (INP) can be associated with prolonged critical illness and extensive antimicrobial exposure. Contemporary microbiology and resistance patterns are poorly characterized. We aimed to describe the microbiology, organism-specific resistance, and antimicrobial burden of INP.

Methods:
 We conducted a retrospective cohort study of adult patients with necrotizing pancreatitis admitted to a tertiary academic hospital between 2019 and 2025 who underwent invasive intervention on pancreatic and/or peripancreatic necrosis. Infection prompting intervention was defined as the presence of gas on computed tomography and/or clinical deterioration; only cultures obtained at the time of the index invasive procedure were analyzed. We described baseline characteristics, microbiology, patient-level antibiotic resistance, and antimicrobial use patterns, focusing on empiric regimens at first antibiotic exposure and antifungal therapy.

Results:
Among 48 patients with INP, mean age was 55.5 ± 16.5 years and median hospital length of stay was 27.5 days (IQR 17.5–67.5); 54.2% required ICU admission and median ICU length of stay was 16.0 days (IQR 8.0–30.0). Evidence of infection prior to intervention included gas on CT in 22/48 (45.8%) and clinical deterioration in 26/48 (54.2%). Bacteria were isolated in 44/48 patients (91.7%) and fungal species in 11/48 (22.9%). The most common organisms were Escherichia coli (29.2%), Enterococcus faecium (22.9%), Candida albicans (14.6%), Enterococcus faecalis (14.6%), and Staphylococcus epidermidis (14.6%); 70.5% of infections were polymicrobial. 34/44 (77.3%) had at least one antibiotic-resistant isolate. Empiric regimens at first antibiotic exposure most commonly included piperacillin–tazobactam (24/48, 50.0%), meropenem (11/48, 22.9%), vancomycin (9/48, 18.8%), metronidazole (8/48, 16.7%), and cefepime (7/48, 14.6%). Among patients who received these agents empirically and had susceptibility data, resistant isolates were identified in 5/22 (22.7%) for piperacillin–tazobactam, 1/10 (10.0%) for meropenem, 0/6 (0%) for cefepime, 2/8 (25.0%) for vancomycin. Despite fungal isolation in only 11/48 (22.9%), 31/48 (64.6%) received at least one antifungal agent, most commonly micafungin (41.7%) and fluconazole (25.0%).

Conclusions:
 Infected necrotizing pancreatitis is characterized by polymicrobial collections with both gram-positive and gram-negative organisms and frequent antibiotic resistance. These findings highlight INP as a major target for antimicrobial stewardship and suggest that organism-specific resistance data should inform future empiric antimicrobial and antifungal strategies.

Microbiota Transplantation Therapy Opposes Oral-Gut Translocation in Colorectal Surgery Patients

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Microbiota Transplantation Therapy Opposes Oral-Gut Translocation in Colorectal Surgery Patients

Authors:
Julia Frebault, Max Hill, Alexander Troester, Christopher Staley, Cyrus Jahansouz

Body of Abstract:
Background

In colorectal surgery, following surgical bowel preparation and colon resection, there are alterations of key genera in the gut microbiome. A rise in pathogenic genera in the postoperative period, particularly Streptococcus, has been linked to postoperative complications including anastomotic leak and surgical site infection. We hypothesized that the source of Streptococcus is the oral microbiome, and that fecal microbiota transplantation therapy (MTT) can repopulate beneficial genera and oppose the translocation of Streptococcus in the postoperative period.

 

Methods

This analysis was conducted in two phases: first, an exploratory cohort of 12 patients in whom fecal and saliva samples were analyzed surrounding resectional colon surgery (n=5) or colonoscopy (controls, n=7). Second, an interventional cohort of 12 patients who underwent colon resection for cancer or diverticular disease received microbiota transplant therapy (MTT) via orally-ingested formulation (IND 30860) and provided fecal samples for analysis. Samples were analyzed at up to six timepoints: pre-operative, within 24 hours of surgery (DOS), postoperative day (POD)10-14, POD30, POD90, and POD180. Microbial composition was assessed with 16S rRNA sequencing. Alpha and beta diversity was analyzed using mothur software. SourceTracker assessed the similarity of postoperative composition to donors as well as to patients’ own preoperative microbiota. Groups were compared using ANOVA, Kruskal-Wallis, and Spearman methods.

 

Results 

In the exploratory cohort, microbial diversity, assessed by Shannon index, differed significantly between surgical and control patients on the day of procedure through POD10 in saliva samples (P = 0.003 and 0.05, respectively), and at POD10 in fecal samples (P = 0.022). Streptococcus was present in higher abundance in the saliva and stool of surgical patients compared to controls. Surgical fecal samples maintained increased similarity to saliva samples compared to controls on DOS, persisting through POD10 (P = 0.29 and 0.04, respectively, Figure 1AB). In the interventional cohort, immediately following surgery, samples had 8.8% similarity to donor, which rose to 81.1% by POD90 (Figure 1C). Following MTT, engraftment was significantly negatively correlated with Streptococcus abundance (-0.61; P<0.01). As Streptococcus abundance declined, a rise in  commensal genera including Blautia and Faecalibacterium was noted (Figure 1D).   Conclusions In this two-part exploration of shifts in microbiota following colorectal surgery, oral translocation of Streptococcus was effectively prevented by oral administration of MTT. Further evaluation of the immunologic reaction to these changes and correlation with clinical outcomes will be beneficial in the development of MTT as a therapeutic intervention surrounding colorectal surgery.

Multidisciplinary Facial Fracture Antibiotic Prophylaxis Guideline: Barriers to Implementation in Practice

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Multidisciplinary Facial Fracture Antibiotic Prophylaxis Guideline: Barriers to Implementation in Practice

Authors:
Terra Hill, Stepheny Berry, Robert Winfield, John Flynn, Clint Humphrey, Duncan Nickerson, Matt Shoemaker, Christopher Guidry

Body of Abstract:
Introduction: Despite evidence against the use of prophylactic antibiotics for patients with facial fractures, their use remains widespread. Our institution created a multidisciplinary practice management guideline (PMG) recommending against the use of prophylactic antibiotics for these patients; however, rates of use were persistent. This study evaluates the perception and beliefs of our multidisciplinary team to assess barriers of the PMG implementation,

Methods: An IRB-approved, REDCap-generated survey was administered to Advanced Practice Providers (APPs), Trainees (Residents and Fellows), and Faculty in the departments of Trauma, Ophthalmology, Otolaryngology (ENT), and Plastic and Reconstructive Surgery (PRS) regarding the perception and beliefs of prophylactic antibiotic use for traumatic facial fractures. This study was conducted at our American College of Surgeons (ACS)-verified Level I Trauma Center. Chi-square and Kruskal-Wallis analyses were conducted.

Results: The survey response rate was 48.4% (75/155). The respondents were primarily trainees (38, 50.6%) and affiliated within the Trauma department (33, 44%). The unawareness of an existing PMG included 9 (100%) Ophthalmology providers, 11 (57.9%) of PRS providers, and 6 (42.9%) of ENT providers (p < 0.0001). The lack of awareness was not statistically significantly different amongst different levels of providers (p= 0.12). In addition, 17 (51.5%) of Trauma providers do not believe prophylactic antibiotics reduce the risk of infection for traumatic facial fractures, whereas 7 (77.8%) of Ophthalmology providers, 7 (50%) of ENT providers, and 16 (84.2%) of PRS providers believes that the risk can vary (p= 0.004). This belief was not statistically significantly different amongst different levels of providers (p= 0.69). Conclusion:  Barriers to implementing a multidisciplinary PMG include persistent beliefs in antibiotic prophylaxis, lack of shared medical knowledge, as well as the lack of information sharing between departments. When creating a multidisciplinary PMG, inclusion of all impacted providers should be considered to effectively implement new changes to clinical practices.