Prophylactic antibiotics in orthopaedic surgery: guidelines and practice.

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Clinical Practice Guidelines

Background:

• National guidelines recommend prophylactic antibiotics for orthopedic procedures like joint replacements and fracture fixation.
• Assessing current antibiotic prophylaxis practices in a state-level hospital is crucial for adherence and patient safety.

Purpose of the Study:

• To evaluate the current antibiotic prophylaxis practices in a state-level hospital for orthopedic surgeries.
• To compare actual practices against national clinical practice guidelines.

Main Methods:

• A prospective study included 103 patients undergoing internal fixation for closed fractures and joint replacement surgery.
• Data collected included pre- and post-operative antibiotic choice, dosage, and duration.
• Documentation in case notes and drug charts verified antibiotic administration.

Main Results:

• 88% received pre-operative and 92% received post-operative antibiotics.
• Cefuroxime was common for fracture fixation, while cefoperazone was used for joint replacements.
• Post-operative antibiotic duration was highly variable (56% unspecified, 10% ≥48 hours); single-dose prophylaxis was rare.

Conclusions:

• Prophylactic antibiotic use is prevalent in orthopedic surgery at this hospital.
• First-line guideline-recommended antibiotics were not used; second and third-generation cephalosporins were favored.
• Current practices show significant deviation from national guidelines regarding antibiotic choice and duration.