Journal of Orthopedics, Traumatology and Rehabilitation (Jan 2018)

Short-course perioperative antibiotic prophylaxis to prevent surgical site infection in elective orthopedic surgery

  • Nitin Kumar Agrawal,
  • Mohammad Jesan Khan,
  • Mohammad Khalid Anwar Sherwani,
  • Mohammad Zahid,
  • Sohail Ahmad,
  • Indu Shukla

DOI
https://doi.org/10.4103/jotr.jotr_20_18
Journal volume & issue
Vol. 10, no. 1
pp. 67 – 71

Abstract

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Context: Antimicrobial prophylaxis has been accepted as a universal protocol for reducing postoperative complications related to infections in surgical practice. Controversy still exists regarding the type of antibiotic and duration of administration for various surgical maneuvers. Aims: This study was conducted to compare the efficacy of short course of perioperative antibiotic prophylaxis against the long-term administration of antibiotics for the prevention of surgical site infections (SSIs). Settings and Design: This was a prospective, randomized, two arm, and open-label study. Subjects and Methods: All patients of either sex, who were admitted in orthopedic wards and planned for elective orthopedic surgical procedures, were included in the study. This was a prospective study, conducted from June 2011 to December 2012. Patients were randomly allocated into two groups. Group A (n = 153) was given 3 doses of 1 g intravenous (IV) ceftriaxone in combination with amikacin (15 mg/kg) perioperatively at an interval of 12 h and Group B (n = 142) was given the usual regimen (5 days of IV antibiotics [ceftriaxone 50 mg/kg twice daily in combination with amikacin 15 mg/kg 12 hourly], accompanied by oral cefuroxime, till elimination of stitches). Statistical Analysis Used: Chi-square test and Student's t-test were used for calculating the difference in rates of infection with 95% confidence intervals. Results: Out of the 295 patients, 13 patients suffered SSI. In Group “A,” superficial infection rate was 3.27% and deep infection rate was 1.31%, while in Group “B,” superficial infection rate was 1.41% and deep infection rate was 2.82%. The difference in infection rates between the two groups was statistically insignificant. Conclusions: There is no role of continuing prophylactic antibiotics beyond 24 h in elective orthopedic surgery to prevent SSI, rather it increases morbidity, mortality, cost for the patients, and antibiotic resistance. Short-course antimicrobial prophylaxis is equally good and as effective as the long-term dosage.

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