Five Day Antibiotic Prophylaxis for Major Lower Limb Amputation Reduces Wound Infection Rates and the Length of In-hospital Stay

Abstract

To compare wound infection, revision rates and hospital stay after major lower limb amputation between patients receiving 24 hours versus 5 days of prophylactic antibiotics. The outcomes of a consecutive series of 40 major lower limb amputations in patients receiving a short 24-hour course of combined prophylactic antibiotics (flucloxacillin/vancomycin + gentamicin/ciproxin + metronidazole) were retrospectively analysed. Following this a further consecutive group of 40 major lower limb amputations were studied prospectively following the institution of a 5-day combined regime using the same antibiotics. The 2 groups of patients were similar in terms of demographics, vascular risk factors and level of amputation. The 5-day antibiotic regime led to a significant reduction in wound infection rates (5% vs. 22.5%, P=0.023) and a reduced length of hospital stay (22 vs. 34 days, P=0.001). Revision rates were lower (2.5% vs. 10%) but did not reach statistical significance (P=0.36). More patients in the prospective 5-day antibiotic series were operated on by the vascular trainee. (77.5% vs. 55% P=0.033). This data supports the use of a prolonged 5-day course of combined antibiotics after major lower limb amputation. This appears to reduce stump infection rates leading to shorter in-hospital stay.