Antibiotics In Orthopedic Surgery Research Articles

A comparative study of one day versus three days peri-operative use of prophylactic antibiotics in orthopedic surgery

Prophylactic systemic antibiotics is the standard practice to prevent surgical site infections in orthopedic surgery including arthroplasty. There is enough evidence showing its utility in preventing or reducing surgical site infection. Timing of administration, antibiotics to be used and duration of antibiotics are controversial points regarding this practice. The present study using Ceftriaxone 1 gram intravenously 3 doses during 24 hours peri-operative period (group 1 n =58) versus 3 days (group 2 n= 57) has been carried out on planned orthopedic surgeries with specific exclusion and followed up for 1 year. None of the cases of either group developed any infection. The study demonstrates the utility of antibiotics prophylaxis and is a step in deciding guidelines about antibiotics use in our country.

Effect of Prophylactic Antibiotics in Orthopaedic Surgery

Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection

Preventing surgical site infection and safe usage of antibiotics in orthopaedic surgery

This article displays the current principles in prevention of Surgical Site Infection and therapy of Antibiotics in Orthopaedic and Trauma Surgery. It also explains the various guidelines for safe usage with precise choice of Antibiotics in Orthopaedic and Trauma Surgery.

Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery.

Surgical site infection (SSI) is one of the most common complications after orthopaedic surgery, leading to significant morbidity and its associated costs. Surgical guidelines strongly recommend the use of systemic antibiotic prophylaxis to reduce the risk for developing SSI. Locally administered powdered antibiotics have the potential to provide remarkably high intra-wound concentrations without risk for systemic toxicity. However, a paucity of high quality evidence in the orthopaedic literature has prevented widespread adoption of this technique. The majority of clinical studies on local intra-wound antibiotics have evaluated the use of topical powdered vancomycin in spinal surgery, though only a single prospective study currently exists. This review will discuss all the available evidence describing the effectiveness, pharmacokinetics, and potential adverse effects with the use of topical powdered antibiotics in orthopedic surgery.

Antibiotic-loaded bone void filler accelerates healing in a femoral condylar rat model.

Demineralised bone matrix (DBM) is rarely used for the local delivery of prophylactic antibiotics. Our aim, in this study, was to show that a graft with a bioactive glass and DBM combination, which is currently available for clinical use, can be loaded with tobramycin and release levels of antibiotic greater than the minimum inhibitory concentration for Staphylococcus aureus without interfering with the bone healing properties of the graft, thus protecting the graft and surrounding tissues from infection. Antibiotic was loaded into a graft and subsequently evaluated for drug elution kinetics and the inhibition of bacterial growth. A rat femoral condylar plug model was used to determine the effect of the graft, loaded with antibiotic, on bone healing. We found that tobramycin loaded into a graft composed of bioglass and DBM eluted antibiotic above the minimum inhibitory concentration for three days in vitro. It was also found that the antibiotic loaded into the graft produced no adverse effects on the bone healing properties of the DBM at a lower level of antibiotic. This antibiotic-loaded bone void filler may represent a promising option for the delivery of local antibiotics in orthopaedic surgery. Cite this article: Bone Joint J 2016;98-B:1126-31.

Three-dimensional printing of antibiotics-loaded poly-ε-caprolactone/poly(lactic-co-glycolic acid) scaffolds for treatment of chronic osteomyelitis

Osteomyelitis, an infection and inflammation of bone marrow, often progresses to chronic stage because of delay in diagnosis and treatment. Once it becomes chronic, intravenous antibiotics therapy is no longer effective as swollen surrounding tissue interrupts blood flow into the infected tissue. In severe cases, debridement of the necrotic tissue becomes necessary to prevent further infection. In this study, for the first time, we produced three-dimensional (3D) printed antibiotics-loaded biodegradable poly-e-caprolactone/poly(lactic-co-glycolic acid) scaffold for treatment of chronic osteomyelitis. Subsequent bone regeneration in debrided site was also observed with the customized scaffolds fabricated using 3D printing. Tobramycin, one of the most widely used antibiotics in orthopedic surgery, was chosen due to its thermostable nature compliant to the heat-based fabrication conditions. In in vitro tests, antibacterial and anti-inflammatory effects and release profile of tobramycin from the scaffold were evaluated to verify the potential of our scaffold as a drug delivery system. In addition, in vivo efficacy of the developed drug loaded scaffolds for treatment of chronic osteomyelitis was also examined in a rat model.

Prophylactic antibiotics in orthopedic surgery: Controversial issues in its use.

Prophylactic antibiotics in orthopedic surgery: Controversial issues in its use.

Preoperative prophylactic antibiotics in orthopaedic surgery: duration of antibiotic administration

Background: Surgical site infection is one of the most dreaded complications faced by an orthopaedic surgeon. Objective: To find out the effect of duration of prophylactic antibiotics on the rate of surgical site infection in clean elective orthopaedic surgeries. Methods: We conducted a randomized controlled trial involving 207 clean elective orthopaedic patients undergoing surgery. The patients were divided into three groups which received intravenous prophylactic antibiotics for 24 hours, 48 hours and 48 hours followed by 7 days of oral antibiotics respectively. The patients were followed up for three months. Results: There was no significant difference in the rate of surgical site infection among the three groups. Conclusion: We conclude that there is no benefit in prolonging preoperative prophylactic antibiotics beyond 24 hours. Health Renaissance, January-April 2013; Vol. 11 No.1; 62-67 DOI: http://dx.doi.org/10.3126/hren.v11i1.7604

Timing of prophylactic antibiotic administration in an orthopedic hospital in a developing country

Background: Appropriate timing of administration is crucial to the effectiveness of prophylactic antibiotics in preventing surgical site infection. Poor adherence to perioperative antibiotic prophylaxis recommendations has been documented from developed countries, but there is a paucity of data on this subject from Nigeria. The aim of this study was to assess the timeliness of administration of the first dose of prophylactic antibiotics in orthopedic surgery. Materials and Methods: In this observational study in an orthopedic practice, administration of antibiotics in operations done over a 6-month period was investigated. The main outcome measure was timing of antibiotic administration in relation to skin incision and tourniquet application. Optimum timing was defined as prophylactic antibiotic administration 15-60 min before skin incision or tourniquet application. Univariate analysis was performed using CDC-Epi Info TM Version 3.5.1 (August 2008). Results: There were 102 procedures out of which 95 (93.1%) were performed without a tourniquet. Of these 95 procedures, antibiotics were given before skin incision in 53 (55.8%) procedures and administration was optimum only in 16 (16.8%) procedures. The median induction-incision interval was 19 min (range: 3-45 min). Conclusion: Timing of perioperative antibiotic administration was inadequate. Routine administration at induction of anesthesia may promote optimum timing and can be considered as in any practice where no written perioperative antibiotic protocol exists.

Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better

Background and purpose There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working.Methods In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records.Results 45% (95% CI: 36–54) of the patients operated in Lund and 57% (CI: 50–64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15–45 min before the start of surgery. 53% (CI: 46–61) received antibiotics 15–45 min before inflation of a tourniquet.Interpretation The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.

Prophylactic Antibiotics in Orthopaedic Surgery

The use of prophylactic antibiotics in orthopaedic surgery is effective in reducing surgical site infections in hip and knee arthroplasty, spine surgery, and open reduction and internal fixation of fractures. To maximize the beneficial effect of prophylactic antibiotics while minimizing adverse effects, the correct antimicrobial agent must be selected, the drug must be administered just before incision, and the duration of administration should not exceed 24 hours.

Randomized prospective study on prophylactic antibiotics in clean orthopedic surgery in one ward for 1 year

BackgroundAt present in Japan, there are neither reports on antibiotic prophylaxis regardless of underlying diseases nor precise guidelines on prophylactic antibiotics in orthopedic surgery. Therefore, the preventive effect of antimicrobial agents on surgical site infection (SSI) after clean orthopedic surgery was studied to control the prevalence of methicillinresistant Staphylococcus aureus (MRSA) in our ward and to reduce SSI caused by MRSA. MethodsRegardless of the type of operation or underlying disease, a regimen of prophylaxis that is of shorter duration than before was conducted in 419 patients admitted to our orthopedic ward (one ward) and who underwent clean orthopedic surgery between 2001 and 2002. ResultsThe annual usage of β-lactam antibiotics in the ward decreased by 960.9g, the isolation rate of MRSA in the ward decreased to 50% (the lowest isolation rate in the past 4years), and SSIs caused by MRSA were found in 3 of 419 (0.71%) patients in one year compared with 6 of 470 (1.28%) during the previous year. Comparison of two antibiotics revealed that SSI caused by MRSA did not occur in any of the 187 patients receiving sulbactam/ampicillin as prophylaxis but did occur in 1.29% (3/232) patients receiving cefazolin. Concerning all SSIs caused by any organisms, they occurred in 0.53% of patients receiving sulbactam/ampicillin and in 2.16% of patients receiving cefazolin. The difference in the SSI rates between the two groups was not statistically significant. ConclusionsAlthough there is statistically no significant difference in the incidence of SSI caused by MRSA, we were able to decrease the isolation rates of MRSA and prevent MRSA from spreading owing to the reduced antibiotic usage in this study. Sulbactam/ampicillin can be recommended, as well as cefazolin, for antibiotic prophylaxis in clean orthopedic surgery.

Antibiotic Prophylaxis in Orthopedic Surgery

This review covers four areas: the use of prophylactic antibiotics in orthopedic surgery not involving prosthetic devices; the use of prophylactic antibiotics in prosthetic joint implantation; the use of antibiotic-containing cement in prosthetic joint surgery; and the use of prophylactic antibiotics for dental procedures in individuals with implanted prosthetic joints. The major conclusions are as follows: (1) Prophylactic antimicrobial agents lower the rate of wound infection following surgery for closed hip fractures. (2) Antimicrobial prophylaxis reduces the frequency of deep wound infection following total joint replacement; operating rooms with ultraclean air have a similar effect. (3) Antibiotic-impregnated cement is as effective as systemic antibiotics in preventing early infection following total joint replacement. (4) For routine dental work in most patients with total joint replacement, there is insufficient evidence to support antibiotic prophylaxis; for such individuals with periodontal disease or potential dental infection, antimicrobial prophylaxis seems indicated.

Use of prophylactic antibiotics in orthopedic surgery.

The use of prophylactic antibiotics was studied prospectively in 2371 consecutive clean orthopedic operations. The infection rates for operations with obvious selection for antibiotic prophylaxis were twice as high (7.2%) as compared with operations with planned prophylaxis (3.4%) and with operations without such prophylaxis (3.7%). Sixteen per cent of all clean operations received antibiotics for prophylaxis and 85 per cent of all prophylactic courses lasted at least 8 days or longer. Fifty-one per cent of all antimicrobial drugs used during the study were administered for prophylaxis in clean orthopaedic operations. The length of the hospital stay was the only factor closely related to the length of antibiotic prophylaxis. The drugs most often used for prophylaxis were penicillinase-resistent penicillins. Significant increase of gram-negative pathogens was observed in cultures from wounds of patients on antibiotic prophylaxis.

Antibiotics in orthopedic surgery.

Antibiotics in orthopedic surgery.

Wound Sepsis in Orthopaedic Surgery

To test the effectiveness of postoperative prophylactic antibiotics in orthopaedic surgery, 331 non-infected surgical candidates were studied at Walter Reed General Hospital over a twelve-month period. The patients were divided at random on the basis of their hospital register numbers into control and experimental groups. One hundred and fifty-nine patients received no antibiotics post-operatively; 172 received chloramphenicol. A two-to-four gram daily dose, based on the patient's weight, was administered for ten days after operation. Statistical analysis revealed that both the control and the experimental groups were comparable with respect to the magnitude and type of surgery, age, and sex. Classification of a wound as infected was based solely on positive bacteriological evidence. See table in the PDF file The rate of postoperative wound infection for the group receiving no antibiotics was 3.8 per cent, whereas that for the group receiving chloramphenicol prophylactically was 6.4 per cent.