Compliance With Antibiotic Prophylaxis in Hip Arthroplasty Following Neck of Femur Fractures: A Retrospective...

Periprosthetic joint infection (PJI) and superficial wound or skin infection are serious complications following hip arthroplasty for neck of femur (NOF) fractures. To reduce these risks, perioperative antibiotic prophylaxis is recommended in national guidance, and our trust's local guideline specifies three postoperative intravenous doses of flucloxacillin or teicoplanin in patients with a penicillin allergy. This audit aimed to assess compliance with this protocol and its association with postoperative wound and skin infection rates.

A retrospective audit study was conducted at Birmingham Heartlands Hospital, part of the University Hospitals Birmingham NHS Foundation Trust, United Kingdom (UK), between October 1 and November 30, 2023. All patients undergoing hip arthroplasty for NOF fractures were included. Data were extracted from the patient information and communication system (PICS), which records clinical notes, medication charts, and operative documentation. The audit standard was defined as 100% compliance with the administration of three postoperative intravenous doses of flucloxacillin or teicoplanin in penicillin-allergic patients, in accordance with the trust's guideline. Patients managed conservatively were excluded.

A total of 179 patients were included (83 intracapsular, 95 extracapsular, and one periprosthetic fracture). Postoperative antibiotics were administered to 150 patients (83.8%), while 29 (16.2%) received none. Flucloxacillin was the most common agent (n=121), with 69.4% (84/121) completing all three recommended doses. Alternative antibiotics included teicoplanin (n=13) for penicillin allergy and co-amoxiclav (n=8), levofloxacin (n=4), clindamycin (n=2), and clarithromycin (n=2) for patients already on antibiotic therapy or with specific clinical indications. Three postoperative wound infections (1.7%) were recorded, two in patients without postoperative antibiotics and one in a teicoplanin-treated penicillin-allergic patient. No PJIs occurred.

Compliance with the trust's guideline was suboptimal, with only 84 of 121 flucloxacillin recipients (69.4%) completing all three postoperative doses. Superficial wound infections occurred in two patients who received no postoperative antibiotics and in one teicoplanin-treated case, and no PJIs were observed. Improved documentation, prescriber education, and routine monitoring are needed to optimise prophylaxis and sustain very low infection rates.