Antibiotic Prophylaxis in Gun Shot Wound (GSW)-related Mandibular Fractures: A Retrospective Chart Review and A Plea for Guideline Revision

PURPOSE: Current guidelines recommend < 24 hours of antibiotic prophylaxis (AP) for operative mandibular fractures. However, these guidelines are based on limited patient populations and weak evidence. This study evaluates the effects of AP in GSW-related mandibular fractures. METHODS: Patients with GSW-related mandibular fractures who presented to a level 1 trauma center (2013-2024) were included. Demographics, clinical characteristics, AP use, and infection rates were collected. Patients were grouped into non-AP and AP cohorts. RESULTS: A total of 133 patients were included: 51 (38.3%) had isolated mandibular fractures and 82 (61.6%) had mandibular and concurrent craniofacial fractures. Of these patients, 114 (85.7%) had AP, while 19 (14.2%) had no AP. Both cohorts had similar demographics: mean age 33 (non-AP) vs. 37.4 years (AP) and male predominance (82.7% (non-AP) and 85.2% (AP)). The overall infection rate was 15% (n = 20/133). The non-AP cohort had higher infection rates than the AP cohort (57.9% vs. 7.89%, p < 0.001). In the isolated mandibular fractures, the total infection rate was 13.7% (n = 7). The non-AP cohort had a a higher infection rate than the AP cohort (50% vs. 8.8%, p = 0.028). Similarly, for mandibular with concurrent craniofacial fractures, total infection rate was 15.9% (n = 13) and the non-AP cohort had higher infection rates than the AP cohort (61.5% vs. 7.25%, p < 0.001). CONCLUSIONS: In this study, GSW-related mandibular fractures have a 50 - 60% risk of infection without AP. AP significantly reduces infection rates, warranting guideline revision for this population.