Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association

Itai Gans,Norachart Sirisreetreerux,Erik A Hasenboehler,Amit Jain,Elliott R Haut

doi:10.1186/s13037-016-0118-5

Itai Gans, Norachart Sirisreetreerux + Show 3 more

Open Access

https://doi.org/10.1186/s13037-016-0118-5

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Abstract

BackgroundThe risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. However, there is no agreement on the superiority of a single- or multiple-dose perioperative regimen of antibiotic prophylaxis. The purpose of this study is to determine the following: 1) What are the current practice patterns of orthopaedic trauma surgeons in using perioperative antibiotics for closed long bone fractures? 2) What is the current knowledge of published antibiotic prophylaxis guidelines among orthopaedic trauma surgeons? 3) Are orthopaedic surgeons willing to change their current practices?MethodsA questionnaire was distributed via email between September and December 2015 to 955 Orthopaedic Trauma Association members, of whom 297 (31%) responded.ResultsMost surgeons (96%) use cefazolin as first-line infection prophylaxis. Fifty-nine percent used a multiple-dose antibiotic regimen, 39% used a single-dose regimen, and 2% varied this decision according to patient factors. Thirty-six percent said they were unfamiliar with Centers for Disease Control and Prevention (CDC) antibiotic prophylaxis guidelines; only 30% were able to select the correct CDC recommendation from a multiple-choice list. However, 44% of surgeons said they followed CDC recommendations. Fifty-six percent answered that a single-dose antibiotic prophylaxis regimen was not inferior to a multiple-dose regimen. If a level-I study comparing a single preoperative dose versus multiple perioperative antibiotic dosing regimen for treatment of closed long bone fractures were published, most respondents (64%) said they would fully follow these guidelines, and 22% said they would partially change their practice to follow these guidelines.ConclusionThere is heterogeneity in the use of single- versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single- versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures.

Highlights

The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use
The American Academy of Orthopaedic Surgeons Committee on Patient Safety published guidelines in 2009 [14, 15] recommending perioperative antibiotic treatment to include a single preoperative dose and intraoperative redosing based on procedure length and blood loss and to discontinue antibiotics within 24 h after wound closure; the recommendations do not specify whether a single preoperative antibiotic dose or a 24-h prophylaxis regimen is recommended
Current practice patterns Most respondents (96%, n = 284) used cefazolin as their preferred first-line prophylaxis antibiotic for treatment of closed long bone fractures (Table 1)

Summary

Introduction

The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. The Centers for Disease Control and Prevention (CDC) Infection Control and Hospital Epidemiology guidelines published in 1999 recommend that antibiotics be re-administered if the duration of surgery is expected to exceed the time during which therapeutic levels of the antibiotic can be maintained and, at most, until a few hours after the surgery has ended [1]. These guidelines, do not indicate whether postoperative continuation of antibiotic prophylaxis is necessary. Recent reviews have highlighted the controversy that exists in the literature in selection of an antibiotic dosing regimen for prevention of surgical site infection; there is widespread use, there is no agreed-upon agent or dosing duration that has been found to be statistically superior [13, 16, 17]

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