A Real World Study On Comparing The Effect Of Cefonicid And Cefuroxime As Prophylaxis For Closed Limbs Fractures ORIF

Objective:Open reduction internal fixation（ORIF）is the most common method to treat limbs fracture which can fix the bone and enhance wound healing.The foreign body is implanted to fix the bone that increases the chance for developing surgical site infection（SSI）,once infected,patients not only have to suffer from damage that hard to heal,but also have to bear the economic and social burden.The most common used prophylactic antibiotic is the 2^nd-generation cephalosporin—cefuroxime and is recommended by guideline in China.After decades of widely using,recently,we found that the resistance rate was at a high level.Antibiotic rotation is helpful for declining the bacteria resistance through lower the selective stress of bacteria.Therefore,we chose cefonicid,a 2^nd-generation cephalosporin which only gave once daily due to its long half-life compared with cefuroxime.We decided to compare the efficacy,antibiotic use density and cost to find out whether cefonicid is suitable to be a prophylaxis for ORIF.Method:This study is a retrospective cohort study conducted in real world circumstance.1.Patients were selected conducted Open Reduction Internal fixation due to closed limbs fracture in a tertiary hospital of Inner Mongolia from January 2015 to2020 December,clinical files of all patients were followed 1 year after the procedure.Checked clinical records of patients and collected examine and test result.Groups were set according to the type of prophylactic antibiotic（Cefonicid and Cefuroxime）;2.Compared the baseline characteristics between two groups and conducted a 1:1propensity score matching（PSM）to balance the bias.Checked and recorded the clinical symptoms,inflammatory markers and details of prophylactic antibiotic use.Compared the SSI rate and symptoms of two groups;3.Risk factors including advanced age,overweight,smoking status,alcohol consumption,length of preoperative hospital stay≥7 days,surgery duration≥180 minutes were recorded.Compared which regime could provide protection under different risk factors;4.SPSS 22.0（SPSS,Chicago,Illinois,USA）was used for all statistical analysis.The t test was used to compare continuous data between cefonicid group and cefuroxime group,whereas Chi-square test was used for categorical data.A two-sided P value of<0.05 was considered statistically significant.Result:A total of 747 patients with limb fractures met the inclusion criteria.Through a1:1 Propensity score matching,each group had 290 patients.6 patients developed SSI in cefonicid group（SSI rate:2.07%）and 7 patients in cefuroxime group（SSI rate:2.41%）which were not statistically significant（P>0.05）.Odds ratio study showed that either prophylaxis would provide no extra protection against risk factors like:surgery duration≥180min,smoke,alcohol,preoperative hospital stay>7days.Inflammatory markers showed no difference between two group.Patients administrated cefonicid（7.25±5.33d vs 9.19±7.46d）spent significantly less days of postoperative hospital stay.The mean AUD of cefonicid and cefuroxime from January 2019 to December 2020were 2.24±0.54 DDD/100 patient-days and 3.32±0.91 DDD/100 patient-days,prophylactic cefonicid associated with a significantly lower AUD（P<0.05）,and the trend of both regimes declined during the period.The average cost of cefonicid significantly lower than cefuroxime（238.14±129.98 RMB vs.293.14±96.37 RMB,P<0.05）.Conclusion:Under real world circumstances,prophylactic cefonicid showed similar effect to cefuroxime in closed limbs fracture ORIF,but cefonicid had the advantage of once daily administration,lower antibiotic cost and lower AUD which can improve compliance of patience and decrease antibiotic resistance.Cefonicid is a suitable prophylactic antibiotic for ORIF perioperatively.