Evidence map›Paper›PMID 42053819›Full record

ArticleArchives of orthopaedic and trauma surgery2026

Antibiotic prophylaxis for open lower extremity fractures: a comparative propensity-scored matched analysis of cefazolin vs. piperacillin-tazobactam.

Kush S Mody, Anish K Ponna, Ryan T Santilli, Andrew Laychur, Joseph Galloway, Mark Adams, Mark Reilly, Sheldon Lin

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Archives of orthopaedic and trauma surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kush S ModyNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Anish K PonnaCollege of Medicine, Drexel University, Philadelphia, USA. akp94@drexel.edu.
Ryan T SantilliCollege of Medicine, Drexel University, Philadelphia, USA.
Andrew LaychurNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Joseph GallowayNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Mark AdamsNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Mark ReillyNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.
Sheldon LinNew Jersey Medical School, Rutgers, The State University of New Jersey, Newark, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionOptimal antibiotic prophylaxis for open fractures remains controversial, particularly regarding whether broader-spectrum regimens offer clinical advantages over cefazolin monotherapy. Despite guideline recommendations supporting first-generation cephalosporins for most open fractures, many centers routinely administer piperacillin-tazobactam. This study aims to evaluate differences in postoperative outcomes between cefazolin and piperacillin-tazobactam in lower extremity open fractures across all Gustilo-Anderson types. MATERIALS AND

methodsThis retrospective cohort study was performed using the TriNetX database to identify adult patients with Gustilo-Anderson type I-III lower extremity open fractures who received either cefazolin or piperacillin-tazobactam. 1:1 propensity score matching controlled for age, sex, demographics, and relevant comorbidities. Outcomes were assessed at 90 days and 1 year using risk ratios (RR) with corresponding 95% confidence intervals.

resultsA total of 47,692 patients met inclusion criteria prior to matching. After matching, 1,527 patients remained in each treatment group for the combined type I/II/III cohort and similar matched pairs were obtained for type I/II and type III subgroups. At 90 days, cefazolin was associated with significantly lower rates of surgical site infection (RR 0.569), osteomyelitis (RR 0.292), sepsis (RR 0.244), reoperation (RR 0.474), readmission (RR 0.518), thromboembolic events (RR 0.480), AKI (0.448), and mortality (RR 0.208) across most analyses. Nonunion/malunion rates were similar between groups for type I/II and the combined cohort (p > 0.05), but higher among type III fractures treated with cefazolin (RR1.933). At 1 year, cefazolin was associated with significantly lower reoperation (RR 0.564), implant removal (RR 0.585), and mortality (RR 0.298) across all analyses, with persistently higher nonunion/malunion risk in type III fractures (RR 1.929).

conclusionCefazolin was associated with comparable or superior outcomes to piperacillin-tazobactam for most postoperative complications following lower extremity open fractures. These findings support current guideline-aligned stewardship practices and question the routine use of broader-spectrum prophylaxis, particularly outside specific contamination scenarios. LEVEL OF EVIDENCE: III - Retrospective Comparative Study.

Indexed as

Anti-Bacterial AgentsAntibiotic ProphylaxisCefazolinFractures, OpenPenicillanic AcidPiperacillin, Tazobactam Drug CombinationAdultAgedFemaleHumansMaleMiddle AgedPiperacillinPropensity ScoreRetrospective StudiesSurgical Wound InfectionAnti-Bacterial AgentsCefazolinPenicillanic AcidPiperacillinPiperacillin, Tazobactam Drug CombinationAntibiotic prophylaxisCefazolinOpen fracturesPiperacillin-tazobactam

Identifiers

PMID42053819
PMCPMC13128684

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.