[Perioperative antibiotic prophylaxis in trauma surgery and orthopedics]

Perioperative antibiotic prophylaxis (PAP) is a key component of infection prevention in trauma surgery and orthopedics. The new German S3 guidelines recommend a single-shot PAP dose for most procedures, particularly joint arthroplasty, osteosynthesis of closed fractures and other elective operations. Open fractures require pre-emptive antibiotic treatment for a maximum of 24 h in type I and type II fractures and for a maximum of 72 h in type III open fractures. Patients with an open distal phalanx fracture of the finger should not receive PAP. In knee arthroscopy PAP is recommended when foreign material is implanted or when cartilage or bone procedures are performed. In shoulder arthroscopy PAP is generally recommended. In spinal surgery PAP is recommended irrespective of instrumentation. The standard is cefazolin 2 g i.v. or cefuroxime 1.5 g i.v., administered approximately 30 min before skin incision. Prolonged antibiotic administration should be avoided.