Orthopedic Surgical Site Infection: Incidence, Predisposing factors, and Prevention

Najjar, Yahya W.; Saleh, Mohammad

doi:10.18535/ijmsci/v4i2.04

Cited by 6 publications

(7 citation statements)

References 29 publications

(103 reference statements)

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“…This is in line with multiple previous studies showing lower infection rates for women after orthopaedic surgeries. 1,8,17,18 The 4 surgeons in this study are all foot and ankle fellow shiptrained and have similar practices. They use similar perioperative techniques aside from prescribing postopera tive antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

et al. 2022

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Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery. Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity. Results: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity. Conclusion: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.

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Section: Discussionmentioning

confidence: 99%

“…This is in line with multiple previous studies showing lower infection rates for women after orthopaedic surgeries. 1,8,17,18…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

et al. 2022

View full text Add to dashboard Cite

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“…SSIs in orthopedic surgery have a variety of clinical, financial, and social consequences, including longer hospital stays, increased morbidity and mortality, increased risk of readmission and revision surgery (debridement), higher treatment costs, and compromised health outcomes. 6 , 9 The presence of either too many replicating microbes (≥ 10 5 CFU/gram of tissue) or too many species in the wound base has a detrimental effect on the development of infection and delays wound healing. 10 The infection can manifest as superficial incisions, deep incisions, bone infections, or infections involving a newly-implanted prosthetic device, resulting from an adverse reaction to an infectious agent or its toxin.…”

Section: Introductionmentioning

confidence: 99%

“…11 , 13 , 14 Several factors influence orthopedic surgery wound healing and determine the likelihood for infection, in addition to the level of microbial contamination at an incision site, which has been a major issue. 6 , 13 , 15 , 16 These include host factors (such as dietary state, lifestyle, comorbidities, immune status, and concurrent infections), and pre-, intra-, and post-operative procedural-related variables, as well as the surgeon’s ability or performance. 1 , 4 , 16 However, some variables are not modifiable, such as age and gender, while other potential factors can be improved to increase the likelihood of a successful surgical outcome.…”

Section: Introductionmentioning

confidence: 99%

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Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia

Alelign¹,

Tefera²,

Tadesse³

et al. 2022

IDR

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Background In the thoughts of all orthopedicians, the emergence of drug-resistant and biofilm-forming bacterial infections at orthopedic surgical sites is the most feared problem. Thus, this study aimed to determine the bacteriological profiles, antimicrobial susceptibility patterns, and biofilm forming ability of isolates, as well as factors associated with orthopedic surgical site infections (OSSIs). Methods An institution-based cross-sectional study was conducted from March 1st, 2021, to February 30th, 2022 at Arba Minch General Hospital. About 245 suspected orthopedic patients with surgical site infection were enrolled and structured questionnaires were used to collect the required information. Wound swabs or pus aspirates were aseptically collected. The frequency and type of bacterial pathogen(s), antimicrobial susceptibility pattern, and biofilm formation were used to determine and characterize the magnitude of OSSIs. SPSS version 25 was used to analyze factors associated with OSSIs. Results The overall magnitude of symptomatic OSSIs was 29.4% (72/245). External fixation [AOR = 4.761, 95% CI: (1.108–20.457)], implant use [AOR = 3.470, 95% CI: (1.460–8.246)], length of time for surgery [AOR = 3.225, 95% CI: (1.545–6.731)], and post-operative hospitalization [AOR = 4.099, 95% CI: (2.026–8.293)] were all statistically significant. Staphylococcus aureus was the most frequently isolated bacteria, accounting for 76%. Methicillin-resistant was observed in 57.9% and 40% of isolated S. aureus (MRSA) and coagulase-negative staphylococci (CoNS), respectively. One-third of the isolated E. faecium was vancomycin-resistant (VRE). Overall, 67.1% (51/76) of isolates were multidrug-resistant (MDR). About 27.6% (21/76) of isolates were found to be strong biofilm producers. Conclusion OSSIs were shown to be caused by a significant number of drug-resistant and biofilm-producing bacterial isolates. To mitigate the problem, aseptic surgical practice and conventional wound management, as well as constant observation of antimicrobial resistant patterns, should be followed.

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Arthroscopic rotator cuff repair without antibiotic prophylaxis does not increase the infection rate

Baraza

Simon

Leith

2021

Knee Surg Sports Traumatol Arthrosc

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PurposeRotator cuff repair is a commonly performed shoulder procedure. In the past 20 years, there has been a shift from mini‐open towards arthroscopic repair, and many units exclusively use arthroscopic techniques for rotator cuff surgery. The aim of this study was to find out whether withholding antibiotics had any effect on the infection rate in patients undergoing arthroscopic rotator cuff repair. MethodsA retrospective analysis of 336 consecutive patients with an arthroscopic rotator cuff repair (RCR) and a minimum 2‐year follow‐up was performed. The control group received prophylactic antibiotics (controls) and the cases of interest did not receive perioperative antibiotics. A power analysis was performed according to literature regarding infection proportions. The primary outcome was an infection (superficial or deep) in the operated shoulder. ResultsThere were 336 patients who underwent a RCR. Two‐hundred‐and‐twelve in the control group and 124 in the non‐antibiotic group. Average ages were 57.3 ± 12.5 and 56.8 ± 13.2 years in each group, respectively. The follow‐up times ranged from 24 to 76 months. Equipment used and surgical techniques were identical, only operating times were statistically different between the groups (control 77.2 ± 41.3 min versus no antibiotic cases 52.9 ± 16.7 min) (p = 0.000009). There was no recorded infection in either group. ConclusionInfection following arthroscopic surgery is uncommon. Small incisions, constant lavage with saline, minimal hardware insertion and short operating times all combine to minimise the risks. Current results point towards no detriment in withholding prophylactic antibiotics in low‐risk patients undergoing routine rotator cuff repair surgery. Therefore, judicious use of prophylactic antibiotics in patients undergoing this procedure is advocated to prevent potential harm to those it is administered to. Level of evidenceLevel III.

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Orthopedic Surgical Site Infection: Incidence, Predisposing factors, and Prevention

Cited by 6 publications

References 29 publications

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery

Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia

Arthroscopic rotator cuff repair without antibiotic prophylaxis does not increase the infection rate

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