Antibiotic prophylaxis in orthopedic surgeries: the results of an implemented protocol

Abstract

Though the basic principles of antibiotic prophylaxis have been well established, there is still considerable incorrect usage, including how much is prescribed and especially in the duration of treatment, which is generally superior to what is indicated. The adequate use of these drugs contributes towards decreasing the time of internment of the patient, prevents surgical site infection (SSI), decreasing the development of resistant microorganisms, and towards reduced costs for the hospital pharmacy. A protocol for the use of antibiotic prophylaxis in the Orthopedics and Traumatology Service of the Hospital do Servidor Público Estadual de São Paulo was developed. The objectives of the study were to promote rational antibiotic surgical prophylaxis, through the implantation of a protocol for the use of these drugs in a surgical unit, with the direct contribution of a druggist in collaboration with the Infection Control Committee, to evaluate the adhesion of the health team to the protocol during three distinct periods (daily pre-protocol, early post-protocol and late post-protocol) and to define the consumption of antimicrobials used, measured as daily defined dose.

Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

“…The data extracted in the review cannot provide a quantification of the importance of each single implementation method, but some of the included studies reported what the authors stressed as important factors for success. Multidisciplinary team approach and interdisciplinary consensus were mentioned in 6 out of 11 successful studies [21,23,24,[27][28][29]. Other aspects mentioned as impactful were personal training [19,29], continuous training and feedback [24,29], monthly analysis [21], active involvement of every member and physician leadership [21,24] and patience [24].…”

Assessment of surgical antimicrobial prophylaxis in Orthopaedics and Traumatology Surgical Unit of a Tertiary Care Teaching Hospital in Addis Ababa

“…Yet, 30–90% of these SAPs are inappropriate; most antimicrobials are either given at the wrong time, wrong dosage and wrong strength which results in increased antibiotic usage, increased costs, prolonged hospitalization, super infection, and antimicrobial resistance [5, 8, 9]. Moreover, SAP protocols should be revised, as cost of antimicrobials and resistance change [10].…”

Surgical antibiotic prophylaxis: is the clinical practice based on evidence?

“…They did not find a significant difference between the group that used one dose of cefazolin and three doses of placebo, and the group that used four doses of cefazolin. Queiroz et al, (6) assessed 3 months of SAP utilisation in the orthopedics ward after the implementation of a SAP protocol. They reported 105.0 DDD/1,000 inpatient-days of SAP utilisation.…”

“…Zhang et al, (5) observed that SAP was administered 2 hours before surgical incision, with a utilisation duration ranging from 1 to 14 days. Queiroz et al, (6) reported that only 3.3% of SAP prescriptions were without error. Even with hospital SAP protocols, there are discrepancies in antimicrobial utilisation, as reported by Khakhkhar et al, (7) and Schmitt et al (8) The efficacy of SAP is determined by plasma concentrations of antimicrobial agents that prevent microbial growth during surgical procedures.…”