Results of Preprocedure and Postprocedure Toe Cultures in Orthopaedic Surgery

Abstract

This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

“…Most surgeons preferred cephalexin 500 mg four times a day, and the duration most commonly was 5 to 7 days. Staphylococcus species is the most commonly isolated organism in postoperative infections in patients having general orthopaedic and foot and ankle surgery [3,13,21,39,46,47,52,58,61,65]. This is consistent with the recommendation for a first-generation cephalosporin as preoperative prophylaxis for patients having orthopaedic procedures [2,3,10,52,54], and our participants' preferred cephalexin as their first-line prophylactic postoperative oral antibiotic.…”

“…Multiple studies have reported postpreparation forefoot cultures ranging from 0% to 84%, most reporting greater than 50% [7,12,28,30,48,63,65]. Studies also have shown intraoperative forefoot recolonization [12,63,65]. Interestingly, despite the reported increased surgical site infection rates, only 11% of respondents reported an indication for prophylactic postoperative oral antibiotics to be the forefoot as surgical site.…”

“…Ostrander et al [47] reported positive cultures after application of surgical preparation solution in 125 patients, ranging from 23% to 98% from the hallux nailfold and second and third web spaces, compared with 10% to 35% from the anterior tibia control. Multiple studies have reported postpreparation forefoot cultures ranging from 0% to 84%, most reporting greater than 50% [7,12,28,30,48,63,65]. Studies also have shown intraoperative forefoot recolonization [12,63,65].…”

“…Other comorbidities associated with increased risk of postoperative infection include obesity, malnutrition, tobacco use, and immunosuppressive medication [11,21,43,45]. Another potential cause for greater concern for surgical site infections after foot and ankle surgery is the persistent colonization of the forefoot despite preoperative preparation [7,12,30,47,48,63,65]. Ostrander et al [47] reported positive cultures after application of surgical preparation solution in 125 patients, ranging from 23% to 98% from the hallux nailfold and second and third web spaces, compared with 10% to 35% from the anterior tibia control.…”

Efficacy of intraoperative surgical irrigation with polihexanide and nitrofurazone in reducing bacterial load after nail removal surgery

“…[1][2][3][4][5][6] The difficulty of bacterial elimination from the forefoot before surgery is well documented. [7][8][9][10] The peculiar anatomy of the foot and its large number of resident micro-organisms may help explain the relatively high infection rates observed with foot and ankle surgery. The optimal skin and nail preparation for foot and ankle surgery remains uncertain.…”