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Background <p>Surgical-site infections (SSIs) following maxillofacial fracture repair can severely complicate recovery, leading to hardware failure and increased reoperation rates. While international guidelines typically recommend short-course β-lactam prophylaxis, these recommendations often do not account for the high-risk profiles such as poor oral hygiene, delay in treatment, and substance abuse often encountered in resource-limited settings. This study evaluated the efficacy of a standardized tripleantibiotic prophylaxis regimen integrated with a perioperative supportive care bundle</p> Methods <p>We conducted a retrospective cohort study of 257 adult patients who underwent Open Reduction and Internal Fixation (ORIF) for maxillofacial fractures between January 2022 and December 2024. To ensure standardization, all patients were treated using government-tendered Titanium miniplates. The prophylaxis protocol consisted of Amoxicillin-Clavulanate (1.2g), Metronidazole (500mg), and dose-specific Amikacin (500mg/7.5mg/kg). This was combined with a supportive bundle including chlorhexidine rinses, glycaemic control, nutritional support, and substance cessation counselling. The primary outcome was 30-day SSI based on CDC/NHSN criteria. Secondary outcomes analysed infection rates by anatomical location (mandible vs. midface) and bundle adherence.</p> Results <p>The mean age of the cohort was 34.2 ± 12.5 years, with a male predominance (68%). Fracture patterns included mandible (42%), zygoma (31%), midface (18%), and combined fractures (9%). The overall SSI rate was 7.0% (18 patients). Anatomical analysis revealed that mandibular fractures carried the highest burden of infection compared to midface or zygomatic fractures. High adherence to the perioperative bundle significantly reduced the risk of SSI (3.5% vs. 12.4%, p&lt;0.01). Independent predictors of infection included smoking, poor oral hygiene, and chronic opium addiction. Adverse effects were minimal, with transient nephrotoxicity observed in 1.6% of patients. </p> Conclusion <p>In a high-risk trauma population, a triple-antibiotic regimen combined with a structured perioperative bundle resulted in low infection rates and an acceptable safety profile. The use of standardized titanium hardware eliminated material variability as a confounder. However, adherence to the supportive bundle was crucial for success. Future randomized controlled trials are needed to validate this intensive approach against standard protocols.</p>

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Triple-Antibiotic Prophylaxis (Amoxicillin-Clavulanate, Amikacin, Metronidazole) Combined with a Perioperative Supportive Bundle in Maxillofacial Trauma Surgery: A Retrospective Cohort Study from India

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Chandrashekhar Chattopadhyay,
  • Vikas Deo,
  • Charu Chouhan,
  • Mamta Patel,
  • Priti Airun,
  • Sugandha Jain

摘要

Background

Surgical-site infections (SSIs) following maxillofacial fracture repair can severely complicate recovery, leading to hardware failure and increased reoperation rates. While international guidelines typically recommend short-course β-lactam prophylaxis, these recommendations often do not account for the high-risk profiles such as poor oral hygiene, delay in treatment, and substance abuse often encountered in resource-limited settings. This study evaluated the efficacy of a standardized tripleantibiotic prophylaxis regimen integrated with a perioperative supportive care bundle

Methods

We conducted a retrospective cohort study of 257 adult patients who underwent Open Reduction and Internal Fixation (ORIF) for maxillofacial fractures between January 2022 and December 2024. To ensure standardization, all patients were treated using government-tendered Titanium miniplates. The prophylaxis protocol consisted of Amoxicillin-Clavulanate (1.2g), Metronidazole (500mg), and dose-specific Amikacin (500mg/7.5mg/kg). This was combined with a supportive bundle including chlorhexidine rinses, glycaemic control, nutritional support, and substance cessation counselling. The primary outcome was 30-day SSI based on CDC/NHSN criteria. Secondary outcomes analysed infection rates by anatomical location (mandible vs. midface) and bundle adherence.

Results

The mean age of the cohort was 34.2 ± 12.5 years, with a male predominance (68%). Fracture patterns included mandible (42%), zygoma (31%), midface (18%), and combined fractures (9%). The overall SSI rate was 7.0% (18 patients). Anatomical analysis revealed that mandibular fractures carried the highest burden of infection compared to midface or zygomatic fractures. High adherence to the perioperative bundle significantly reduced the risk of SSI (3.5% vs. 12.4%, p<0.01). Independent predictors of infection included smoking, poor oral hygiene, and chronic opium addiction. Adverse effects were minimal, with transient nephrotoxicity observed in 1.6% of patients.

Conclusion

In a high-risk trauma population, a triple-antibiotic regimen combined with a structured perioperative bundle resulted in low infection rates and an acceptable safety profile. The use of standardized titanium hardware eliminated material variability as a confounder. However, adherence to the supportive bundle was crucial for success. Future randomized controlled trials are needed to validate this intensive approach against standard protocols.