Surgical Infection Society: Chest Wall Injury Society Recommendations for Antibiotic Use during Surgical Stabilization of Traumatic Rib or Sternal Fractures to Reduce Risk of Implant Infection

Joseph D. Forrester, Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Marko Bukur, Division of Acute Care Surgery, Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA.
Justin E. Dvorak, Division of Trauma, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.
Bradley Faliks, Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
David Hindin, Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Susan Kartiko, Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Tareq Kheirbek, Department of Surgery, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA.
Leo Lin, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
Morgan Manasa, Department of General Surgery, University of California, Irvine, Irvine, California, USA.
Thomas J. Martin, Department of Surgery, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA.
Richard Miskimins, Division of Acute Care Surgery, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA.
Bhavik Patel, Gold Coast University Hospital, Southport, Queensland, Australia.
Fredric M. Pieracci, Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
Kaitlin A. Ritter, Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
Sebastian D. Schubl, Department of General Surgery, University of California, Irvine, Irvine, California, USA.
Jamie Tung, Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Jared M. Huston, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

Surgical infections

Volume

23

Issue

4

DOI

10.1089/sur.2022.025

Keywords

antibiotic agents; implant; infection; rib fractures; surgery; trauma

Abstract

Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection. Although implant infection rates after SSRF and SSSF are low, they present a challenging clinical entity often requiring prolonged antibiotic therapy, debridement, and potentially implant removal. The Surgical Infection Society's Therapeutics and Guidelines Committee and Chest Wall Injury Society's Publication Committee convened to develop recommendations for antibiotic use during and after surgical stabilization of traumatic rib and sternal fractures. Clinical scenarios included patients with concomitant infectious processes (sepsis, pneumonia, empyema, cellulitis) or sources of contamination (open chest, gross contamination) incurred as a result of their trauma and present at the time of their surgical stabilization. PubMed, Embase, and Cochrane databases were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. For patients undergoing SSRF or SSSF in the absence of pre-existing infectious process, there is insufficient evidence to suggest existing peri-operative guidelines or recommendations are inadequate. For patients undergoing SSRF or SSSF in the presence of sepsis, pneumonia, or an empyema, there is insufficient evidence to provide recommendations on duration and choice of antibiotic. This decision may be informed by existing guidelines for the concomitant infection. For patients undergoing SSRF or SSSF with an open or contaminated chest there is insufficient evidence to provide specific antibiotic recommendations. This guideline document summarizes the current Surgical Infection Society and Chest Wall Injury Society recommendations regarding antibiotic use during and after surgical stabilization of traumatic rib or sternal fractures. Limited evidence exists in the chest wall surgical stabilization literature and further studies should be performed to delineate risk of implant infection among patients undergoing SSSRF or SSSF with concomitant infectious processes.

Department

Surgery

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