Antibiotic prophylaxis for wound infections in total joint arthroplasty - A systematic review
ABSTRACT We reviewed systematically the published evidence on the effectiveness of antibiotic prophylaxis for the reduction of wound infection in patients undergoing total hip and total knee replacement. Publications were identified using the Cochrane Library, MEDLINE, EMBASE and CINAHL databases. We also contacted authors to identify unpublished trials. We included randomised controlled trials which compared any prophylaxis with none, the administration of systemic antibiotics with that of those in cement, cephalosporins with glycopeptides, cephalosporins with penicillin-derivatives, and second-generation with first-generation cephalosporins. A total of 26 studies (11 343 participants) met the inclusion criteria. Methodological quality was variable. In a meta-analysis of seven studies (3065 participants) antibiotic prophylaxis reduced the absolute risk of wound infection by 8% and the relative risk by 81% compared with no prophylaxis (p < 0.00001). No other comparison showed a significant difference in clinical effect. Antibiotic prophylaxis should be routine in joint replacement but the choice of agent should be made on the basis of cost and local availability.
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ABSTRACT: Some controversy exists regarding the use of antibiotic prophylaxis in elective foot and ankle surgery. A task force was appointed by the American College of Foot and Ankle Surgeons (ACFAS) to provide a clinical consensus statement on this topic. The panel members performed a literature search and identified 6 studies that met the inclusion criteria. They then developed a list of 13 questions about which they attempted to reach consensus using a modified Delphi method. The questions were grouped into 4 categories: indications for antibiotic prophylaxis relative to surgical procedure; antibiotic prophylaxis in high-risk patients; antibiotic selection; and timing of antibiotic prophylaxis. Consensus was reached for all 13 questions. The panel members found that studies pertaining specifically to elective foot and ankle surgeries that were not level I evidence generally did not recommend prophylaxis. They also found that multispecialty guidelines, which reflect data that are stronger, tended to recommend routine prophylaxis, especially for surgeries involving hardware. In addition, many hospital systems support routine prophylaxis by surgeons. More high-level evidence is required to make a definitive determination about whether prophylaxis is necessary in elective foot and ankle surgery. Until that time, routine prophylaxis will likely be continued at most institutions, because few complications have been reported with the practice. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 01/2015; 54(2). DOI:10.1053/j.jfas.2015.01.004 · 0.98 Impact Factor
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ABSTRACT: In the last century, an open fracture of the lower extremity would result in amputation and/or death until Joseph Lister described the antiseptic principle. The prepared mind must understand Lister to reduce infection. Lister described washing hands and reducing bacterial counts in the operating room (OR) through clean air techniques. Lister washed his hands, instruments, wounds, bandages, and sprayed carbolic acid to reduce bacteria. Evidence-based medicine supports simple measures, such as limiting OR traffic and personnel, wearing gowns and gloves, and carefully preparing the operative site. Charnley enforced the principles of Lister with laminar flow. OR efficiency and the use of antibiotic cement prevent infection. Data support preoperative antibiotics as the most important factor in reducing infection. Protocols for decolonization reduce infection. The prepared mind focuses on reducing the bacterial count in the OR and uses the host's ability to fight off infection.Seminars in Arthroplasty 03/2010; 21(1):42-44. DOI:10.1053/j.sart.2009.12.010
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ABSTRACT: Periprosthetic joint infection is one of the most common causes of failure after total hip arthroplasty. After strict sterile technique, the use of appropriate perioperative antibiotics administered before the skin incision is the most effective method to prevent infection. We have also found that a 3-minute dilute (0.35%) betadine lavage before closure has been helpful in decreasing the risk of periprosthetic joint infection. When treating the chronically infected total hip arthroplasty, debridement should be avoided, and a 2-stage exchange protocol remains the gold standard in North America.Seminars in Arthroplasty 09/2012; 23(3):135-140. DOI:10.1053/j.sart.2012.07.002