[Perioperative antibiotic prophylaxis. Use in orthopaedics]

Area of Science:

• Infectious Diseases
• Orthopaedic Surgery
• Pharmacology

Context:

• Antibiotic prophylaxis is crucial in preventing surgical site infections (SSIs) in orthopaedic procedures.
• The use of foreign bodies, such as prosthetic joints, necessitates specific prophylactic protocols.
• Current guidelines emphasize targeted antibiotic use to balance efficacy and resistance concerns.

Purpose:

• To define the appropriate indications for perioperative antibiotic prophylaxis in orthopaedic surgery.
• To recommend specific antibiotic classes and administration timing for optimal SSI prevention.
• To highlight evidence-based practices regarding the duration of antibiotic prophylaxis.

Summary:

• Antibiotic prophylaxis in orthopaedics is indicated solely for procedures involving foreign bodies like prosthetic joints.
• First or second-generation cephalosporins are the preferred agents, administered within 30 minutes pre-incision.
• Repeated doses may be considered for surgeries exceeding 3 hours; prolonged prophylaxis (over 24 hours) is not beneficial and contributes to resistance.
• Surveillance of SSIs is essential to maintain low infection rates (<1%) and prevent antimicrobial resistance.

Impact:

• Optimized antibiotic strategies reduce the incidence of SSIs in orthopaedic patients.
• Adherence to evidence-based prophylaxis minimizes the development of antibiotic resistance.
• Enforced surveillance systems help maintain high standards of surgical hygiene and patient safety.