JOT - 2026-06-01 - Journal Article; Comparative Study
Ceftriaxone Versus Piperacillin-Tazobactam Monotherapy for Open Fracture Prophylaxis: A Retrospective Cohort Study.
Sisson AH, Litten RM, McIlwain RN, Kimbel AN, Alcaide DM, Cimino AM, Johnson JP, Spitler CA
Topics
Key Takeaway
Ceftriaxone and piperacillin-tazobactam monotherapy produced equivalent FRI rates (25.4% vs. 29.0%, P=0.501) and AKI rates (11.9% vs. 15.9%, P=0.636) in 136 open fracture patients, while diabetes independently predicted FRI (OR 6.62, P=0.003).
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Summary
This single-center retrospective cohort compared FRI and AKI rates in 136 open fracture patients (femur, tibia, humerus, radius/ulna, foot) receiving CTX (n=67) or PIP-TAZ (n=69) monotherapy after operative irrigation and debridement from 2020–2023. FRI rates were 25.4% vs. 29.0% (P=0.501) and AKI rates were 11.9% vs. 15.9% (P=0.636), with no statistically significant difference between groups. On multivariate analysis, diabetes was the only independent predictor of FRI (OR 6.62, P=0.003); soil contamination (OR 3.42) and external fixation (OR 1.92) trended toward risk but did not reach significance.
Key Limitation
Exclusion of cases requiring flap coverage or vascular bypass eliminates the Gustilo IIIB/IIIC subset where antibiotic spectrum differences between CTX and PIP-TAZ are most clinically relevant, making the equivalence finding applicable only to lower-grade open fractures.
Original Abstract
OBJECTIVE
To compare rates of fracture-related infection (FRI) and acute kidney injury (AKI) in patients with open fractures treated with ceftriaxone (CTX) monotherapy or piperacillin-tazobactam (PIP-TAZ) monotherapy.
DESIGN
Retrospective cohort study.
SETTING
Single Level I Trauma Center (2020-2023).
PATIENT SELECTION CRITERIA
Adults who sustained an open fracture of the femur, tibia, humerus, radius/ulna, and foot fractures (metatarsals, calcaneus, talus) and underwent operative irrigation and debridement. Exclusion criteria were less than 6 months of follow-up, hospital transfers, primary amputation, receipt of vancomycin within the first 48 hours in addition to CTX or PIP-TAZ, and cases requiring vascular bypass, rotational or free flaps, or full-thickness skin grafts.
OUTCOME MEASURES AND COMPARISONS
Primary outcomes were rates FRI and AKI. Outcomes were compared between patients receiving prophylactic CTX versus PIP-TAZ monotherapy.
RESULTS
A total of 156 patients with open fractures were identified, of which 136 met inclusion criteria: 67 treated with CTX monotherapy and 69 with PIP-TAZ monotherapy. The mean age was 46.2 years (range: 18-86) in the CTX cohort and 41.6 years (range: 19-83) in the PIP-TAZ cohort, and males comprised 56.7% and 72.3% of each group, respectively. Differences between groups were limited to a longer mean follow-up duration in the PIP-TAZ cohort ( P < 0.001) and a higher prevalence of soil contamination in the CTX cohort (11.9% vs. 1.4%, P = 0.015). There were no statistically significant differences in rates of FRI (25.4% CTX vs. 29.0% PIP-TAZ, P = 0.501) or AKI (11.9% vs. 15.9%, P = 0.636) between groups. On multivariate analysis, diabetes (OR 6.62, P = 0.003) was independently associated with increased FRI risk, whereas soil contamination (OR 3.42, P = 0.180) and external fixation (OR 1.92, P = 0.163) demonstrated nonsignificant trends toward higher risk.
CONCLUSIONS
In this retrospective cohort of patients with open fractures, ceftriaxone and piperacillin-tazobactam demonstrated comparable outcomes in both fracture-related infection and acute kidney injury. Diabetes was found to be a statistically significant risk factor for FRI.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.