Pyogenic infections in orthopedic surgery. Prevention and management

Area of Science:

• Infectious Diseases
• Surgical Practice
• Antimicrobial Stewardship

Background:

• Hospital-acquired infections are a significant clinical challenge, frequently caused by staphylococcal bacteria.
• Staphylococcal strains exhibit variable resistance to common antibiotics, complicating treatment and prophylaxis.
• The widespread use of antibiotics for routine surgical prophylaxis warrants critical reassessment due to potential risks and benefits.

Purpose of the Study:

• To evaluate the efficacy and safety of current antibiotic prophylaxis practices in surgery.
• To differentiate between situations requiring and not requiring antibiotic prophylaxis.
• To advocate for a more discriminate approach to prophylactic antibiotic use in clinical settings.

Main Methods:

• Review of clinical practice regarding antibiotic prophylaxis in surgical procedures.
• Analysis of infection rates and antibiotic resistance patterns in hospital settings.
• Categorization of surgical procedures based on infection risk and need for antibiotic therapy.

Main Results:

• Many procedures, including soft tissue lacerations, clean wounds, and elective orthopedic/plastic surgeries, can be performed safely without prophylactic antibiotics.
• Major orthopedic surgeries (e.g., open fractures, internal fixation, joint operations) require postoperative antibiotic therapy for five days, primarily antistaphylococcal agents.
• Antibiotic therapy is also indicated for major crush injuries and in patients with healing fractures undergoing procedures that may cause bacteremia.

Conclusions:

• A shift from indiscriminate to discriminate prophylactic antibiotic therapy is necessary.
• Surgical technique and procedure duration are critical factors in preventing infections, often negating the need for routine antibiotics.
• Targeted antibiotic use in high-risk surgical scenarios and specific patient conditions optimizes antimicrobial stewardship and patient safety.