Surgical Antimicrobial Prophylaxis in Orthopedic Implant Surgeries: An Analysis of Practices, Outcomes, and Costs

To characterize various regimens used for surgical antimicrobial prophylaxis (SAP) in patients undergoing orthopedic implant surgeries (OISs).

A prospective observational study was conducted in patients undergoing OISs to identify various antimicrobial regimens used for SAP. Patients were followed up for a month to detect signs of surgical site infections (SSIs). Risk factors that increase the likelihood of SSIs were determined. Adherence to standard guidelines for SAP was evaluated. Cost analysis and adverse drug reaction (ADR) profiling of each of the regimens used were also done.

Among the 264 patients included, 11 regimens for SAP were followed. Ceftriaxone + amikacin given for 1-5 days was the most common regimen employed (37.87%). One-day regimens (< 24 h) were more commonly prescribed (34.84%) than all other durations (2-5 days). SSIs were observed in 2.37% of the included patients. Gender, presence of cardiovascular comorbidities, low preoperative Hb, and the choice of antimicrobial regimen selected for SAP were associated with SSIs. The adherence rate to standard guidelines for SAP was 35.5%. In our study, ceftriaxone given for < 24 h was the most cost-effective regimen, with the lowest cost per patient (0.28 USD) and no infections. Procurement of ceftriaxone and amikacin contributed to > 70% of the total cost of SAP. Vomiting, epigastric pain, and thrombophlebitis were the common ADRs observed.

SAP practices for patients undergoing OISs are highly variable, with low adherence to standard guidelines. Development of evidence-based national and institution-specific guidelines, along with regular antibiotic stewardship activities, could help curb the heterogeneity in SAP practices.