Dr. Rakesh Parmar,
Senior Resident, Department of Orthopaedics, ESIPGIMSR, New Delhi, India.
E-mail: rksdoc@gmail.com
Objectives: The objectives of this study were to assess the need for antibiotic prophylaxis in soft-tissue surgeries of short duration without usage of implant in the field of orthopedics.
Methods: A prospective and comparative randomized study was performed on 100 cases with clean elective surgical procedure of short duration <⅟2 h. Data were analyzed for development of surgical site infection (SSI) in clean elective soft-tissue procedures of short duration.
Results: In our carefully selected cohort of patients of clean soft-tissue surgeries of less than half hour duration without involving the use of implant, two groups were made based on block randomization technique, one of which got a shot of pre-operative antibiotic prophylaxis and other did not. Mean patient age was 36.1 years (04 month-66 years). In both groups at all age levels, no infection was found. In the group which received antibiotic 80.8% were female and 19.2% were male, and in the antibiotic not given group had 61.5% female and 38.5% male. Therefore, it is evident that antibiotics did not provide clinical or statistical protection against SSI in clean elective soft-tissue procedures of short duration.
Conclusion: We suggest stratification of use of antibiotic prophylaxis, that is, antibiotic prophylaxis is required for surgeries of longer duration involving placement of implants but not required in surgeries of short duration which do not involve placement of implants in the field of orthopedics.
Keywords: Surgical Prophylaxis, Surgical site infection, Orthopaedics Practice.
References
- 1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32. [Google Scholar]
- 2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control 1999;27:97-132; quiz 133-4, discussion 96. [Google Scholar]
- 3. Curcio D, Cane A, Fernández F, Correa J. Surgical site infection in elective clean and clean-contaminated surgeries in developing countries. Int J Infect Dis 2019;80:34-45. [Google Scholar]
- 4. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 1993;128:79-88. [Google Scholar]
- 5. Bratzler DW. The surgical infection prevention and surgical care improvement projects: Promises and pitfalls. Am Surg 2006;72:1010-6; discussion 1021-30, 1133-48. [Google Scholar]
- 6. Meehan J, Jamali AA, Nguyen H. Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am 2009;91:2480-90. [Google Scholar]
- 7. Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are not indicated in clean general surgery cases. Am J Surg 2001;182:682-6. [Google Scholar]
- 8. Li K, Sambare TD, Jiang SY, Shearer EJ, Douglass NP, Kamal RN. Effectiveness of preoperative antibiotics in preventing surgical site infection after common soft tissue procedures of the hand. Clin Orthop Relat Res 2018;476:664-73. [Google Scholar]
- 9. Ansari SA, Saddique M, Azim WA. Antibiotic prophylaxis in clean surgery. Biomedica 2005;21:121-4. [Google Scholar]
- 10. Olix ML, Klug TJ, Coleman CR, Smith WS. Prophylactic penicillin and streptomycin in elective operations on bones, joints and tendons. Surg Forum 1960;10:818-9. [Google Scholar]
- 11. Pavel A, Smith RL, Ballard A, Larsen IJ. Prophylactic antibiotics in clean orthopedics surgery. J Bone Joint Surg Am 1974;56:777-82. [Google Scholar]
- 12. Pavel A, Smith RL, Ballard A, Larson IJ. Prophylactic antibiotics in elective orthopedic surgery: A prospective study of 1,591 cases. South Med J 1977;70 (Suppl 1):50-5. [Google Scholar]
- 13. Burnakis TG. Surgical antimicrobial prophylaxis: Principles and guidelines. Pharmacotherapy 1984;4:248-71. [Google Scholar]
- 14. Dickemore C, Green R, Jolley W, Green D. Prophylactic Antibiotics in Clean Forefoot Surgery: Are They Necessary? Ch. 19.4; 2002. p. 228-30. [Google Scholar]
- 15. Tosti R, Fowler J, Dwyer J, Maltenfort M, Thoder JJ, Ilyas AM. Is antibiotic prophylaxis necessary in elective soft tissue hand surgery? Orthopedics 2012;35:e829-33. [Google Scholar]
- 16. Ansari SA, Saddique M, Azim WA. Antibiotic prophylaxis in clean surgery. Biomedica 2005;21:121-4. [Google Scholar]