Antibiotic prophylaxis and risk of orbital cellulitis following orbital floor fracture: a real-world evidence study using the TriNetX network

Purpose To determine whether prophylactic antibiotic administration following the development of an orbital floor fracture or after orbital floor fracture repair is associated with a reduced risk of orbital or periorbital cellulitis.Methods A multicenter retrospective cohort study was designed using data obtained from the TriNetX United States Collaborative Network. Patients with orbital floor fractures were categorized by antibiotic exposure within 14 days of diagnosis. Similarly, patients who underwent orbital floor fracture repair were queried to determine whether or not they received antibiotics either at the time of surgery or in the immediate postoperative period. The primary outcome was orbital or periorbital cellulitis within 180 days, assessed after 1:1 propensity-score matching for demographic and clinical variables. Statistical analyses were then performed to determine differences in the two groups.Results Among 3,169 matched pairs, antibiotic use was associated with higher cellulitis incidence after incident orbital floor fracture (1.93% vs 0.57%, respectively; RR = 3.40, p < 0.0001). In 1,116 matched pairs who underwent orbital floor fracture repair, patients who received antibiotics were more likely to develop orbital cellulitis than those that did not (2.69% vs. 1.08%, respectively; RR = 2.50, 95% CI [1.29–4.86], p = 0.005).Conclusion Prophylactic antibiotics did not reduce infection risk after incident orbital floor fracture or after floor fracture repair and were associated with higher cellulitis rates. While clinical decision making may depend on a variety of factors, routine use of antibiotics in these settings may not be appropriate.