D116. The Role of Antibiotics in Nasal Fractures following Closed Reduction

Abstract

PURPOSE: Nasal fractures represent the most common fracture in facial trauma. The role of prophylactic antibiotics in these injuries is debated, given low infection rates and demonstrated risks of antibiotic therapy. We studied the effect of prophylactic antibiotics on infection rate in patients with nasal fracture following closed reduction. METHODS: Retrospective analysis was performed of a prospectively maintained plastic surgery facial trauma database at a Level I trauma center. Demographics, comorbidities, fracture classifications, and management of patients who received antibiotics at the time of closed nasal reduction were compared against those who did not receive antibiotics. Infection rates between groups were analyzed. Multivariate analysis was conducted to control for confounding variables. Qualitative analysis was performed for patients who experienced infection. RESULTS: 282 patients met inclusion criteria (n=144, antibiotic; n=138, non-antibiotic). Six patients experienced infection (1 abscess, 5 sinus infections). There was no difference in local infection rate (2.0% vs 2.2%, p=0.90), upper respiratory infection (0% vs 0%), or pneumonia (0.3% vs 0%, p=0.52) between antibiotic and non-antibiotic groups. On multivariate regression, antibiotics did not significantly decrease odds of infection (OR 1.7, [0.17-13.6], p=0.64). Moreover, patients with open nasal fractures did not have significantly higher odds of infection (OR 1.9, [0.08-20.8], p=0.64). Similarly, increasing severity of injury based on Rohrich Classification did not significantly impact odds of infection (OR 0.68, [0.23-1.9], p=0.46). Qualitative analysis demonstrated all six infections were managed non-operatively. CONCLUSION: Prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction, including in open fracture cases.