Extended-course antibiotic prophylaxis in lower limb amputation: randomized clinical trial

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Clinical Pharmacy

Background:

• Lower limb amputation (LLA) procedures, despite being classified as clean surgery, exhibit high rates of surgical-site infection (SSI).
• Practices for antibiotic prophylaxis in LLA vary considerably, leading to inconsistent patient outcomes.
• This study addresses the need for evidence-based guidelines on optimal antibiotic duration for LLA.

Purpose of the Study:

• To compare the efficacy of a 5-day antibiotic prophylaxis course versus a 24-hour course in preventing SSI after minor and major LLA.
• To evaluate the impact of extended antibiotic prophylaxis on impaired wound healing (IWH) and the need for revisional surgery.
• To assess the influence of SSI and IWH on hospital stay duration and mortality post-LLA.

Main Methods:

• A randomized controlled trial involving patients undergoing minor and major LLA.
• Participants were assigned to receive either a 5-day or a 24-hour prophylactic antibiotic course.
• Outcomes including SSI, IWH, revisional surgery, hospital stay, and mortality were assessed using standardized criteria (ASEPSIS).

Main Results:

• A 5-day antibiotic course was associated with significantly lower SSI rates (11.8% vs. 39.5%) and IWH rates (22.4% vs. 58%) compared to the 24-hour course.
• Patients receiving the 5-day prophylaxis required significantly less revisional surgery (6.6% vs. 21%).
• SSI and IWH were independent predictors for requiring revisional surgery and increased hospital stay.

Conclusions:

• Extended antibiotic prophylaxis (5-day course) is superior to a short course (24-hour) in reducing SSI and IWH following lower limb amputation.
• Implementing a 5-day antibiotic prophylaxis regimen can decrease the need for subsequent surgical interventions.
• These findings support a revised approach to antibiotic prophylaxis in LLA to improve patient outcomes and reduce healthcare costs.