IntroductionSurgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty.Methods and analysisA systematic review of randomised controlled trials, cross-sectional studies, case–control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings.Ethics and disseminationNo ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal.PROSPERO registration numberCRD42020147925.
Cíl studie: Zhodnocení provedení antibiotické profylaxe v chirurgii. Typ studie: Průřezová studie. Typ pracoviště: Zdravotnické zařízení lůžkové péče krajského typu. Materiál a metoda: Antibiotická profylaxe byla zhodnocena u pacientů ≥ 18 let, kteří v definovaném období podstoupili chirurgický výkon a současně vyjádřili svůj souhlas se zpracováním dat pro odborné účely. Data byla sbírána pomocí předem vytvořeného formuláře pro perioperační záznam antibiotické profylaxe (identifikace a pohlaví pacienta, informace o chirurgickém výkonu, název antibiotika, dávka antibiotika, čas podání a délka podávání antibiotika) a ze zdravotnické dokumentace. Nasbíraná data byla porovnána s dostupnými vědeckými poznatky a s interním standardem. Výsledky byly zpracovány deskriptivní statistikou. Výsledky: Studie se zúčastnilo 197 pacientů (103 mužů a 94 žen) v průměrném věku 56,5 let. Nejčastěji byl sledován urologický výkon, a to u 43 (21,8 %) pacientů. Antibiotickou profylaxi obdrželo 125 (63,5 %) pacientů. Indikace antibiotické profylaxe odpovídala z 86,9 % standardu a z 88,9 % dostupným vědeckým poznatkům. U 52 % chirurgických výkonů byl podán cefazolin. Na základě podrobného hodnocení byly v současném interním standardu napříč obory identifikovány některé oblasti vhodné k revizi. Jedná se především o doplnění obecných zásad provedení antibiotické profylaxe, zohlednění individuálních charakteristik pacienta a podrobnější specifikování jednotlivých výkonů dle chirurgických oborů. Závěr: V interním standardu antibiotické profylaxe byly identifikovány jisté rozdíly oproti dostupným vědeckým poznatkům. Určité odlišnosti oproti standardu i aktuálním poznatkům byly shledány i při hodnocení provedení profylaxe v praxi.Klíčová slova: antibiotická profylaxe, infekce v místě chirurgického výkonu, adherence, doporučené postupy. Audit of antibiotic prophylaxis in surgeryObjective: Evaluation of antibiotic prophylaxis in surgery. Design: Cross-sectional study. Setting: Regional healthcare facility. Material and methods: This study assessed patients (≥18 years old) who underwent a surgical operation in the defined period and agreed to participate in the study. Data were collected through the form for antibiotic prophylaxis perioperative record (identification and gender, information about surgical operation, choice of antibiotic, dose of antibiotic, time of administration and duration of it), and from the medical records. Collected data were compared with evidence-based medicine and internal hospital standards. The descriptive statistics were used for evaluation. Results: 197 patients (103 men and 94 women) with average age of 56.5 years attended the study. Urological procedure was most frequently observed in 43 (21.8%) patients. 125 (63.5%) patients received antibiotic prophylaxis. The indication of the antibiotic prophylaxis was correct in 86.9% with the internal hospital standards and in 88.9% with the evidence-based medicine. Cefazolin was administered in the 52% of surgical procedures. Based on the detailed evaluation, some areas for ...
Background Implant-associated infection (IAI) is a potential complication following total hip (THA) or knee arthroplasty (TKA). The initial phase of the inflammatory process can be measured by applying one of the inflammatory blood parameters (IBP). This systematic review aims to assess the response of IBP to trauma caused by orthopedic surgery and evaluate the clinical utility of quantitative measurements of IBP as prognostic factors for infection. Methods All studies indexed in Ovid MEDLINE (PubMed), Ovid EMBASE, the Cochrane Library and the ISI Web of Science databases, from inception until January 31, 2020, were analyzed. Studies included were those on adults who underwent THA or TKA with minimum follow up of 30 days after surgery. In addition to minimum follow up, data on the prognostic factors for pre- or post-THA/TKA IAI were mandatory. The Quality Assessment of Diagnostic Accuracy tool (version 2) (QUADAS-2) and Standards for Reporting of Diagnostic Accuracy Studies guideline 2015 (STARD) were used for quality assessment. Results Twelve studies fulfilled the inclusion and exclusion criteria. C-reactive protein was analyzed in seven studies, interleukin-6 in two studies and erythrocyte sedimentation rate in eight studies. White blood cell count and procalcitonin were analyzed in the only study. The overall quality of included studies was low. A potential for other cytokines (IL-1ra, IL-8) or MCP-1 was observed. Conclusions This is the first systematic review of IBP response to orthopedic surgery which identified some IBP for pre/post-operative screening, despite insufficient data supporting their prognostic potential for patient risk stratification.
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