Prolonged antibiotic prophylaxis use in elective orthopaedic surgery – a cross-sectional analysis

BMC Musculoskeletal Disorders

Andreas Limacher¹  Brigitta Gahl¹  Felix Rohrer²  Tanja Hermann³  Anita Maurer⁴  Jan Bruegger⁵  Hubert Noetzli⁶ 

[1] Clinical Trials Unit (CTU) Bern, University of Bern, 3012, Bern, Switzerland;Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland;Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland;Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland;Stiftung Lindenhof, Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, 3010, Bern, Switzerland;Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland;University of Bern, 3012, Bern, Switzerland;Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland;University of Zurich, 8006, Zurich, Switzerland;University of Bern, 3012, Bern, Switzerland;Orthopaedie Sonnenhof, 3006, Bern, Switzerland;

关键词: Surgical antibiotic prophylaxis;    Prolonged surgical antibiotic prophylaxis;    Surgical site infection;    Orthopaedic surgery;    Elective surgery;    Prevention;   

DOI  :  10.1186/s12891-021-04290-w

来源: Springer

【 摘 要 】

PurposeSurgical antibiotic prophylaxis (SAP) prevents surgical site infections (SSI). In orthopaedic surgery, the use of prolonged SAP (PSAP) has been reported in daily routine, despite guidelines advising against it. Therefore, we asked: What is the proportion of PSAP use, defined as administration of SAP ≥24 h after elective orthopaedic surgery? Are there patient- and surgery-related predictors of PSAP use?MethodsThis cross-sectional analysis investigated 1292 patients who underwent elective orthopaedic surgery including total joint arthroplasties at one Swiss centre between 2015 and 2017. Patient comorbidities, surgical characteristics and occurrence of SSI at 90 days in PSAP group were compared to the SAP group (< 24 h post-operative).ResultsPSAP use was 12% (155 of 1292). Patient-related factors associated with PSAP compared to the SAP group included older age (63 vs. 58y; p < 0.001), higher BMI (29 vs. 27 kg/m2; p < 0.001), ASA classification ≥3 (31% vs. 17%; p < 0.001) and lung disease (17% vs. 9%; p = 0.002). Surgery-related factors associated with PSAP were use of prosthetics (62% vs. 45%; p < 0.001), surgery of the knee (65% vs. 25%; p < 0.001), longer surgery duration (87 vs. 68 min; p < 0.001) and presence of drains (90% vs. 65%; p < 0.001). All four SSI occurred in the SAP group (0 vs. 4; p = 1.0). Surgeons administered PSAP with varying frequencies; proportions ranged from 0 to 33%.ConclusionPSAP use and SSI proportions were lower than reported in the literature. Several patient- and surgery-related factors associated with PSAP use were identified and some were potentially modifiable. Also, experienced surgeons seemed to implement differing approaches regarding the duration of SAP administration.

【 授权许可】

CC BY