Use of Parenteral Prophylactic Antibiotics in Clean Orthopaedic Surgery

Oishi, Calvin S.; Carrion, Wesley V.; Hoaglund, Franklin T.

doi:10.1097/00003086-199311000-00041

Cited by 68 publications

(35 citation statements)

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“…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.…”

Section: Discussionsupporting

confidence: 82%

“…Although many studies support the benefit of preoperative antibiotic prophylaxis for orthopaedic procedures [2,9,14,24,26,46,51,52], few well-controlled studies have examined their effects exclusively in foot and ankle surgery, with several reporting a lack of efficacy. Zgonis et al [66] reviewed a series of elective, primary, nontraumatic, outpatient surgeries on the foot or ankle and found no significant difference in surgical site infection rates between the 306 patients who received preoperative antimicrobial prophylaxis (1.6%) and the 249 who did not (1.4%).…”

Section: Discussionmentioning

confidence: 99%

“…Judicious use of antibiotics is recommended given the association between increased use and the development of antibioticresistant organisms [3,46,53], which are increasingly prevalent [21,52,53]. Therefore, we investigated surgeons' use of prophylactic postoperative oral antibiotics after elective outpatient foot or ankle procedures, identifying the (1) frequency of prescription, (2) regimen preference, (3) indications, and (4) associated surgeon experience, demographics, and reported surgical site infections.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Ruta

Kadakia

Irwin

2014

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ruta

Kadakia

Irwin

2014

Clinical Orthopaedics &Amp; Related Research

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“…The use of prophylactic systemic antibiotics is well established both in general surgery and joint replacement, [9][10][11][12] but there are large variations in the dosage and duration of use and in the inclusion of antibiotics in the bone cement. One large, randomised trial compared the effect of antibiotics given either systemically or in the cement.…”

Section: -8mentioning

confidence: 99%

Antibiotic Prophylaxis in Total Hip Arthroplasty

Espehaug

Engesæter

Vollset

et al. 1997

The Journal of Bone and Joint Surgery. British volume

129

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We have assessed the effect of different regimes of antibiotic prophylaxis on the survival of total hip implants, comparing antibiotics administered both systemically and in the bone cement, systemically only, in the bone cement only and with no antibiotics given.We studied 10 905 primary cemented total hip replacements, performed for osteoarthritis of the hip and reported to the Norwegian arthroplasty register between 1987 and 1995. Cox-estimated failure-rate ratios (FRR) are presented with adjustment for gender, age, the brand of cement, the prosthesis, the type of operating theatre and the operating time.For revisions performed for infection (39 operations), the lowest rate of revision was found among patients receiving antibiotic-containing cement plus systemic antibiotics (n = 5804). The revision rate for the 4586 patients receiving systemic antibiotics only was 4.3 times greater (95% CI 1.7 to 11.0, p = 0.001); in 239 with antibiotics in the bone cement only it was 6.3 times greater (CI 1.6 to 25.0, p = 0.003); and in the 276 who did not receive antibiotics it was by 11.5 times greater (CI 2.1 to 63.0, p = 0.002). Adjustment for the total amount of systemic antibiotic administered did not change the results. We also observed an increased revision rate for aseptic loosening (109 operations) comparing the systemic-only (FRR = 1.8, CI 1.1 to 2.9, p = 0.01) and the cement-only regimes (FRR = 2.6, CI 1.2 to 5.9, p = 0.02) with the combined dosage.Our findings show that systemic antibiotics combined with antibiotic-containing bone cement led to fewer revisions than the other methods.

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“…Continuing antibiotics for longer than 24 hours after wound closure may contribute to the development of antimicrobial resistance [5][6][7] . Administration of prophylactic antibiotics for longer than 24 hours has not been demonstrated to be effective and may actually lead to superinfection with drug-resistant organisms [5][6][7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%