[The paradigm of prophylactic antibiotic therapy in orthopedic surgery]

Show that the infection rate in scheduled orthopedic surgery is less than 2% provided the principles of asepsis, antisepsis and surgical would care are applied, without the administration of prophylactic antibiotics.

A prospective, observational, longitudinal study was conducted in a secondary care hospital of the IMSS system and at Angeles Metropolitano hospital, from January 2, 2006 to April 30, 2008. All male and female patients aged > 1 year undergoing scheduled orthopedic surgery with a complete preoperative protocol were included. Patients admitted for an infectious process were excluded. The wounds were kept dry and covered, and all wound care was omitted during the first five days. Then dry wound care was provided at the doctor's office at postoperative days 5, 10 and 15, when the sutures were removed in the case of soft tissue surgery, and at postoperative days 20 and 25, when the sutures of the surgery involving bone tissue were removed. Patients whose surgery involved nailing were asked to come at postoperative day 30 for nail removal and at postoperative day 60 for final discharge. The observations were made by 3 orthopedic surgeons from the medical units of the study hospitals, 2 of whom performed the surgeries.

A total of 382 scheduled surgeries were performed with infection observed in 3 of them (0.79%). The result of the binomial statistical test was p < .0001.

We have shown that by following a surveillance protocol and applying appropriate asepsis and antisepsis we may omit the use of prophylactic antibiotics in patients scheduled for orthopedic surgery.