ArticleInternational journal of surgery (London, England)2025
Association between the generation of cephalosporins for perioperative prophylaxis and postoperative surgical site infections in open fractures: a prospective cohort study.
Article in International journal of surgery (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors associated with periprosthetic joint infection following total knee arthroplasty: an updated systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2026Pooled it
- Perioperative NSAID use and postoperative outcomes after distal radius fracture surgery: a propensity-matched cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Risk factors for surgical site infection following posterior internal fixation of thoracolumbar fractures.Frontiers in surgery · 2026Article
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe use of cephalosporins for surgical site infection (SSI) prevention has become a clinical routine, however, high-level evidence regarding the optimal generation for open fractures is currently limited. This study aims to investigate the association between the generation of cephalosporins and SSI risk in open fractures.
methodsThis prospective cohort study used data from the Surgical Site Infection in Orthopedic Surgery (SSIOS), a prospectively maintained database, conducted at a tertiary orthopedic university hospital from October 2014 to December 2020. The primary outcome was occurrence of SSI within 1 year after operation, and its association with the generation of cephalosporins was examined using multivariable logistic regressions and generalized estimating equations. Generalized additive models were used to calculate the relative contribution of potential factors likely influencing SSI.
resultsA total of 3582 eligible patients, 74.6% males, with a mean age of 43.7 ± 14.1 years, were included. First-, second-, and third-generation cephalosporins were used in 1957 (54.6%), 1219 (34.0%), and 406 (11.3%) patients. Compared to first-generation cephalosporins, the use of second-generation cephalosporins was significantly associated with a higher risk of SSI (absolute risk difference [ARD] = 3.70%; 95% CI, 1.90%-5.51%; adjusted OR [aOR] = 1.604; 95% CI, 1.212-2.124), whereas third-generation cephalosporins were not (ARD = 1.02%; 95% CI, -1.78% to 3.82%; aOR = 1.234; 95% CI, 0.790-1.880). Among the 28 potential factors considered, the generation of cephalosporins was ranked 9th in terms of its impact on the risk of SSI.
conclusionPerioperative use of higher-generation cephalosporins was not associated with a reduction in postoperative surgical site infections in open fractures. Our study supports existing guidelines that recommend the use of first-generation cephalosporins as the preferred agents for preventing SSIs in open fractures.
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