[Postoperative infectious risk in traumatic bone surgery and protocol for antibiotic therapy]

Area of Science:

• Infectious Disease
• Surgical Infection Prevention
• Operating Room Environment

Background:

• Traumatic injuries necessitate surgical intervention, posing infection risks.
• Advances in operating room (OR) technology aim to minimize microbial contamination.
• Antibiotic prophylaxis is a standard measure to prevent surgical site infections (SSIs).

Purpose of the Study:

• To evaluate the impact of a modern operating room environment on infection rates in trauma surgery.
• To assess the efficacy and safety of short-term (2-day) postoperative Cefazolin prophylaxis.
• To investigate the incidence of antibiotic resistance in surgical site pathogens.

Main Methods:

• Analysis of 1168 consecutive traumatic cases operated in a modern OR with high-efficiency filtration and positive pressure.
• Comparison of infection rates with historical data from a less advanced OR.
• Subgroup analysis of 205 patients receiving 2-day postoperative Cefazolin prophylaxis.
• Monitoring of drain contamination and antibiotic resistance patterns (Gram-negative bacteria to Cefazolin, Staphylococcus to Methicillin).

Main Results:

• Overall infection rate was 0.6% in the modern OR.
• Four cases of severe sepsis (1.9%) occurred in the Cefazolin prophylaxis group.
• 2.1% of drains were contaminated without subsequent infection.
• Increased resistance observed: 60% of Gram-negative organisms to Cefazolin and 30% of Staphylococci to Methicillin.

Conclusions:

• The modern operating room environment is crucial for reducing surgical site infections in trauma care.
• Short-term Cefazolin prophylaxis may be associated with an increased risk of sepsis and does not prevent drain contamination.
• Concerns exist regarding rising antibiotic resistance, suggesting a need for alternative strategies like intraoperative Penicillin M administration.