Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Xu, Sheng Gen; Mao, Zhao Guang; Liu, Bin Sheng; Zhu, Hui Hua; Pan, Hui Lin

doi:10.1016/j.injury.2014.07.026

Cited by 24 publications

(20 citation statements)

References 35 publications

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“…20 Despite their common use, several studies have reported no benefits to postoperative prophylactic antibiotics on the occurrence of SSI in clean orthopedic procedures. [20][21][22][23] In fact, both the Centers of Disease Control and the European Centre for Disease Prevention and Control do not recommend postoperative oral prophylactic antibiotics. 21,22 Postoperative complication rates reported for TPLO vary from 14.8-37% and include infection, osteomyelitis, implant failure, and seroma.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23] In fact, both the Centers of Disease Control and the European Centre for Disease Prevention and Control do not recommend postoperative oral prophylactic antibiotics. 21,22 Postoperative complication rates reported for TPLO vary from 14.8-37% and include infection, osteomyelitis, implant failure, and seroma. 17,23 Infection rates range from 4.7-13%, 17,24 and Priddy et al reported an infection rate for TPLO of 13%, with osteomylitis accounting for 7.3%, incisional infection for 3.1%, septic arthritis for 1.6%, and draining tracts for 0.5%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Andrade¹,

Schmiedt²,

Cornell³

et al. 2016

Veterinary Surgery

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Objective: To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs. Study Design: Prospective clinical study. Sample Population: Client-owned dogs undergoing stifle surgery (n ¼ 100). Methods: IO cultures were taken in each case from surgical foot wrap, peri-incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI. Results: Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%. Conclusion: Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR. In the veterinary literature, surgical site infection (SSI) rates for patients undergoing clean surgical procedures range from 3.6-5.8%. 1-3 Infection occurs despite adherence to well-accepted standards of surgical technique and environmental control designed to maintain a sterile surgical field. 4 Little objective information is available to validate how successfully these techniques control intraoperative contamination of surgical gloves, patient wraps, patient skin, and surgeon skin. In addition, it is not known how bacteria associated with surgical procedures influence complications. Understanding the bacterial ecology of veterinary operating rooms during the intraoperative period is critical in the search for the source of SSI, and allows for the development of evidence-based strategies to control the impact of pathogenic microbes in the surgical environment. In human surgical practice, published intraoperative glove contamination rates range from 14-56%. 5,6 Studies have not reported a clear primary source of contamination. One study reported surgical personnel, followed by the patient, and operating room environment as the most common sources of contamination 7 ; however, another study reported the operating room environment as the major source, followe...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Andrade¹,

Schmiedt²,

Cornell³

et al. 2016

Veterinary Surgery

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“…As well as being ineffective in the prevention of SSIs, the inappropriate use of antibiotics has negative effects on the patient and the hospital microbial ecosystem, which increases the pharmaceutical expense 10-fold [31]. A preoperative, single-dose prophylaxis is adequate [36,37]; prolongation of prophylaxis beyond the first 24 h after surgery is not justified [38][39][40][41][42][43][44][45][46][47][48]. Prolonged use of antimicrobials for prophylaxis is potentially harmful because it fosters the emergence of resistant bacterial strains, which has negative effects on the patient in terms of toxicity and possible development of Clostridium difficile infections, and on the community [49,50], and also increases healthcare costs [51,34].…”

Section: Discussionmentioning

confidence: 99%

Reinforcing good practice: Implementation of guidelines at hospital G. Pini

Nobile

Bronzin

Navone

et al. 2014

Injury

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“…Antibiotic prophylaxis was also shown to be beneficial in elective hysterectomy, plastic surgery, facial fractures among other surgical procedures [10][11][12]. A randomized control trial that evaluated patients with low SSI risk scores undergoing open reduction and internal fixation (ORIF) however found no significant difference in SSI incidence between patients assigned to control group that received cefuroxime for prophylaxis and those in evaluation group that received placebo [13]. They therefore concluded that an SSI risk score could be used to select patients who do not need antibiotic prophylaxis when undergoing surgery.…”

Section: Is Antibiotic Prophylaxis Necessary In Surgery?mentioning

confidence: 99%

Timing and Choice of Antibiotic Prophylaxis for Prevention of Surgical Site Infections: A Systemic Review

Okello¹

2017

UCMS

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BACKGROUND: Surgical site infection (SSI) doubles the mortality, cost, hospital stay and the rate of ICU admission in post operative patients. Parenteral antibiotic administration in the perioperative period is one of the effective strategies for prevention of SSI. However, the practice around administration of antibiotics in this setting is often not standardized, depending mainly on surgeon's preference. OBJECTIVE: We set out to clarify the timing of antibiotic for prophylaxis in surgery and the most appropriate antibiotic choice. METHODS: The study was a systematic review of literature on the subject within the last 5 years. Literature was retrieved from "Google Scholar", "Pubmed" and "Medline". Those that met the eligibility criteria were included and analyzed. RESULTS: The reviewed literature indicated that antibiotic prophylaxis should be administered within 60 minutes before surgical incision and should not be continued beyond 24 to 48 hours. The choice should be guided by local susceptibility patterns, but cefazolin or cefuroxime or ampicillin-sulbactam are used in most settings. Metronidazole should be added when anaerobic organisms are expected. CONCLUSIONS AND RECOMMENDATION: We recommend a review of guidelines or institution of guidelines where none exists, to reinforce the timing and choice of antibiotic for pre-operative prophylaxis.

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Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection

Cited by 24 publications

References 35 publications

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Reinforcing good practice: Implementation of guidelines at hospital G. Pini

Timing and Choice of Antibiotic Prophylaxis for Prevention of Surgical Site Infections: A Systemic Review

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