Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

Gonzalez, Amanda; Suvà, Domizio; Dunkel, Nathalie; Nicodème, Jean-Damien; Lomessy, Antoine Paul; Lauper, Nicolas; Rohner, Peter; Hoffmeyer, Pierre; Uçkay, İlker

doi:10.1007/s00264-014-2395-x

Cited by 13 publications

(10 citation statements)

References 9 publications

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“…Alone, it only reduces absolute SSI risks by some few percent [1]. Second, enhanced antibiotic prophylaxis lacks its final proofs, but might be associated with unnecessary adverse events (even when it is in single doses [24] or administered during three days such as in open fractures [4]). Several author groups proposed different enhancement strategies for non-infected orthopedic surgery: combining with local prophylaxis (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The ideal regimen for perioperative antibiotic prophylaxis for prevention of surgical site infections (SSI) is evidence-based for the majority of clean, non-infected orthopedic procedures [1–4]. However, standard prophylaxis protocols do not recommend specific regimens before re-debridement of patients under already implemented curative antibiotic therapy for an established orthopedic infection (SSI or community-acquired) [1,2].…”

Section: Introductionmentioning

confidence: 99%

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Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections?

et al. 2019

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BackgroundPerioperative antibiotic prophylaxis in non-infected orthopedic surgery is evident, in contrast to prophylaxis during surgery for infection. Epidemiological data are lacking for this particular situation.Methods and findingsIt is a single-center cohort on iterative surgical site infections (SSIs) in infected orthopedic patients. We included 2480 first episodes of orthopedic infections (median age 56 years and 833 immune-suppressed): implant-related infections (n = 648), osteoarticular infections (1153), and 1327 soft tissue infections. The median number of debridement was 1 (range, 1–15 interventions). Overall, 1617 infections (65%) were debrided once compared to 862 cases that were operated multiple times (35%). Upon iterative intraoperative tissue sampling, we detected pathogens in 507 cases (507/862; 59%), of which 241 (242/507; 48%) corresponded to the initial species at the first debridement. We witnessed 265 new SSIs (11% of the cohort) that were resistant to current antibiotic therapy in 174 cases (7% of the cohort). In multivariate analysis, iterative surgical debridements that were performed under current antibiotic administration were associated with new SSIs (odds ratio 1.6, 95%CI 1.2–2.2); mostly occurring after the 2nd debridement. However, we failed to define an ideal hypothetic prophylaxis during antibiotic therapy to prevent further SSIs.ConclusionsSelection of new pathogens resistant to ongoing antibiotic therapy occurs frequently during iterative debridement in orthopedic infections, especially after the 2nd debridement. The new pathogens are however unpredictable. The prevention, if feasible, probably relies on surgical performance and wise indications for re-debridement instead of new maximal prophylactic antibiotic coverage in addition to current therapeutic regimens.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections?

et al. 2019

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“…In the literature, many research groups investigated the influence of a delay between admission and surgery with the occurrence of subsequent infection and its pathogen profile. However, these studies concerned open fractures, with time delays ranging from 0 to 24 h [ 18 ]. We found only one study specifically linking longer hospitalization delays with healthcare-associated infections [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…If surgery lasts for more than 4 h, prophylaxis is repeated. In selected cases, surgeons may continue it up to 24 h; except for open fractures with longer durations of preemptive treatment [ 18 ]. Since 2016, the standard dose was doubled for obese patients with more than 100 kg weight [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay?

Davat

Wuarin

Stafylakis

et al. 2018

Antimicrob Resist Infect Control

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BackgroundProlonged hospital stay before surgery is a risk for colonization with antibiotic-resistant microorganisms and possible antibiotic-resistant surgical site infections (SSI), which lacks acknowledgement in international guidelines for perioperative antibiotic prophylaxis.MethodRetrospective cohort study focusing on prophylaxis-resistant SSI in adult orthopedic implant patients; with emphasis on length of hospital stay prior to the index surgery.ResultsWe enrolled 611 cases of SSI (median age, 65 years; 241 females and 161 immune-suppressed) in four large implant groups: arthroplasties (n = 309), plates (n = 127), spondylodeses (n = 31), and nails (n = 46). The causative pathogen was resistant to the perioperative antibiotic prophylaxis regimen in 307 cases (307/611; 50%), but the length of pre-surgical hospitalization did not influence the incidences of prophylaxis-resistant SSIs. These incidences were (107/211;51%) for the admission day, (170/345;49%) within 10 days of delay, (19/35;54%) between 10 and 20 days, and (11/20; 55%) beyond 20 days of hospital stay before surgery. The corresponding incidences of methicillin-resistant staphylococci were 13%, 14%, 17%, and 5%, respectively. In adjusted group comparisons, the length of prior hospital stay was equally unrelated to future prophylaxis-resistant SSI (odds ratio 1.0, 95% confidence interval 0.99–1.01).ConclusionsIn our retrospective cohort of orthopedic implant SSI, the length of pre-surgical hospital stay was unrelated to the incidence of prophylaxis-resistant pathogens.

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“…after trauma 6,7 or open fractures 8. Simultaneously, we are witnessing a rising prevalence of extended-spectrum beta-lactamase producing-rods body carriage (ESBL) on orthopaedic wards 9.…”

Section: Introductionmentioning

confidence: 99%

Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods?

Jamei¹,

Gjoni²,

Zenelaj³

et al. 2017

J. Bone Joint Infect.

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Background: 1st and 2nd generation cephalosporins used for perioperative prophylaxis in orthopaedic surgery do not cover non-fermenting Gram-negative rods (NFR).Methods: Epidemiological cohort study of adult patients operated for orthopedic infections between 2004 and 2014 with perioperative cefuroxim or vancomycin prophylaxis. Exclusion of polyneuropathic ischemic foot infections and septic bursitis cases.Results: Of the total 1840 surgical procedures in the study, 430 grew Gram-negative pathogens (23%), of which 194 (11%) were due to NFR and 143 (8%) to Pseudomonas aeruginosa. Overall, 634 episodes (35%) involved orthopaedic implants (321 arthroplasties, 135 plates, 53 nails, and others). In multivariate analysis and group comparisons, especially preoperative antibiotic use (124/194 vs. 531/1456; p<0.01) was significantly associated with NFR.Conclusions: Overall proportion of NFR oscillated between 9% and 13% among our orthopaedic infections. Variables associated with NFR were antibiotic use prior to hospitalization. The low infection rate of NFR following elective surgery and the community-based epidemiology, has led us to keep our standard perioperative prophylaxis unchanged.

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Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

Cited by 13 publications

References 9 publications

Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections?

Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections?

Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay?

Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods?

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