{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:59:57Z","timestamp":1790168397013,"version":"4.1.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9,23]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To compare fracture related infection (FRI) rates and outcomes between ceftriaxone (CTX) and cefazolin plus gentamicin (C+G) for antibiotic prophylaxis in Gustilo-Anderson (GA) type III open lower extremity fractures.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n Design<\/jats:italic>\n : Retrospective cohort study.\n <\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Single, academic level one trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Included were patients age 18\u201389 years with GA type III open lower extremity fractures (AO\/OTA 32,33,41,42,43,4F3, 44) from 2013 to 2024 with at least 6 weeks follow-up.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measurements and Comparisons:<\/jats:title>\n The primary outcome was FRI. Secondary outcomes included acute kidney injury (AKI), nonunion, and other complications. Cox proportional hazards models and multivariable logistic regression adjusted for confounding variables.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Of 3,334 lower extremity fractures reviewed, 307 met inclusion criteria: 229 C+G and 78 CTX. Mean age (40.4 [range 18-88] vs 41.2 [range 18-81] years, p=0.7) and sex (75.1% vs 64.1% male, p=0.084) were similar between the C+G and CTX cohorts. Mean follow-up was 23.8 months (C+G) and 14.0 months (CTX) (P=0.002). The C+G cohort had more tibial shaft fractures (34.1% vs 19.2%, P=0.014) and type IIIB injuries (19.7% vs 7.7%, P=0.014). On unadjusted analysis, there was no significant difference in FRI (18.3% vs 12.8%, P=0.343) or AKI (11.4% vs 12.8%, P=0.728) or organisms cultured. After adjusting for GA type, fracture location, time to debridement and time to antibiotics there remained no significant difference in FRI (HR=1.26, 95% CI: 0.59\u20132.68, P=0.545), AKI (OR=1.51, 95% CI: 0.62\u20133.49, P=0.349) or other complications between antibiotic regimens. Tibial shaft fractures trended towards higher risk of FRI compared to femur fractures (HR=2.15, P=0.052). GA type IIIB\/C fractures (HR=3.05, p<0.001) and time to antibiotics of >60min (HR=2.56, p=0.003) were associated with higher odds of FRI.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Ceftriaxone monotherapy demonstrated similar rate of FRI and complications compared to cefazolin plus gentamicin for Gustilo-Anderson type III open lower extremity fractures. Severity of the open fracture and time to antibiotics were independently associated with higher infection risk regardless of antibiotic regimen.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003286","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:00:06Z","timestamp":1790164806000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Ceftriaxone versus cefazolin plus gentamicin for antibiotic prophylaxis in Gustilo-Anderson type III open lower extremity fractures"],"prefix":"10.1097","author":[{"given":"Cameron","family":"Foster","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery and Rehabilitation, University of Florida-Jacksonville, Jacksonville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon","family":"Richardson","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Gainesville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Pegg","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Gainesville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedant","family":"Garg","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Gainesville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Kye","sequence":"additional","affiliation":[{"name":"Medical College of Georgia at Augusta University, Augusta, GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8820-2146","authenticated-orcid":false,"given":"Porter","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Rehabilitation, University of Florida-Jacksonville, Jacksonville, FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003286","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:00:06Z","timestamp":1790164806000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003286","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}