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ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2012, Number 6

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Acta Ortop Mex 2012; 26 (6)

Effect of a short antimicrobial prophylaxis regimen on the prevalence of postoperative infection in elective Orthopedics and Traumatology surgery

Vargas-Mena R, Arredondo-Gómez E, Pavía-Carrillo EF

Language: Spanish
References: 18
Page: 369-374
PDF size: 71.86 Kb.


ABSTRACT

Objective: To assess the efficacy of two antimicrobial prophylaxis regimens, a short cycle and the standard one, on the prevalence of acute postoperative infection in orthopedic surgery for acute and chronic disease of a thoracic and a pelvic limb. Material and methods: Prospective, observational, experimental randomized, double-blind trial in patients undergoing orthopedic surgery due to acute or chronic disease, between April and September 2009. The sample size was determined using the formula to calculate the finite population. Two groups were formed: one was given cefalotin for 24 hours plus ten additional days of dicloxacillin, the standard regimen and a second one that received cefalotin for 24 hours and placebo for ten days. The wound was assessed during hospitalization and it was checked on days 5, 8, 14 and 30. A statistical software was used for the statistical analysis, which included Student’s t-test and χ2, and descriptive statistics for percentages, frequencies, means and standard deviations. The protocol was approved by the local health research committee. Results: One hundred and thirty-one patients were included. Group I included 62 patients with cefalotin/dicloxacillin and Group II 69 patients with cafalotin/placebo for 10 days. In Group I one patient had infection and in Group II there were 3 cases, with p = 0.50 when χ2 was applied. Conclusions: Antimicrobial prophylaxis with 24 hour-cefalotin has the same effect on the prevalence of postoperative infection than a prolonged cycle of cefalotin plus dicloxacillin, according to the χ2 test. It is clear that there is no considerable benefit in giving antibiotics indiscriminately and for long periods of time compared with protection from infection in clean wounds.


REFERENCES

  1. Waddell TK, Rotstein OD: Antimicrobial prophylaxis in surgery. Committee on Antimicrobial Agents, Canadian Infectious Disease Society. CMAJ 1994; 151(7): 925-31.

  2. Fletcher N, Sofianos D, Berkes MB, Obremskey WT: Prevention of perioperative infection. J Bone Joint Surg Am 2007; 89: 1605-18.

  3. Rosales LM, Alpízar A, Miramontes V, Valero-González F, Reyes-Sánchez A: Profilaxis con antibióticos en cirugía ortopédica. Acta Med 2007; 5(1): 35-9.

  4. Novelo-Lara JC: Ensayo clínico controlado entre dos esquemas de profilaxis antibiótica y un placebo, en pacientes con fracturas cerradas. [Tesis de especialización en Ortopedia y Traumatología]. UADY; 2004.

  5. Moller AM, Villebro N, Pedersen T: Effect of preoperative smoking intervention on postoperative complications. Lancet 2002; 359: 114-7.

  6. 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.

  7. Walls RJ, Roche SJ, O’Rourke A, McCabe JP: Surgical site infection with methicillinresistant Staphylococcus aureus after primary total hip replacement. J Bone Joint Surg [Br] 2008; 90-B: 292-8.

  8. Norma Oficial Mexicana de Emergencia NOM-EM-002-SSA2-2003, Para la vigilancia epidemiológica, prevención y control de las infecciones nosocomiales. Diario Oficial de la Federación (2003).

  9. American Society of Health-System Pharmacists. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Am J Health Syst Pharm 1999; 56(18): 1839-88.

  10. Pons-Busom M, Aguas-Compaired M, Delas J, Eguileor-Partearroyo B: Compliance with local guidelines for antibiotic prophylaxis in surgery. Infect Control Hosp Epidemiol 2004; 25: 308-12.

  11. Bernstein J, Meller M, Kelley SS, Heckman JD: Antimicrobial Prophylaxis to Prevent Surgical Site Infection. J Bone Joint Surg Am 2006; 88: 1149-52.

  12. Fitzgerald RH, Thompson RL: Cephalosporin antibiotics in the prevention and treatment of musculoskeletal sepsis. J Bone Joint Surg Am 1983; 65: 1201-5.

  13. Rivera-Ramírez O, Korinek AM: Antibioticoterapia profiláctica en cirugía. Rev Mex Anest 2005; 28(2): 96-108.

  14. Barza M, Miao P: Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics. Part 3: cephalosporins. Am J Hosp Pharm 1977; 34: 621-9.

  15. Siegel S: Estadística no paramétrica. México, D.F.: Ed. Trillas; 1990: 195-225.

  16. Mader JT, Wang J, Calhoun J: Antibiotic Therapy for Musculoskeletal Infections. J Bone Joint Surg Am 2001; 83-A: 1878-90.

  17. Esposito S, Mittelkotter U: Ceftriaxone prophylaxis in abdominal, cardiovascular, thoracic, orthopedic, neurosurgical and general surgery: a review of practice 1996-2003. J Chemother 2005; 17(Suppl 2): 17-32.

  18. Rosenberg AD, Wambold D, Kraemer L, Begley-Keyes M, Zuckerman SL, Singh N, et al: Ensuring Appropriate Timing of Antimicrobial Prophylaxis. J Bone Joint Surg Am 2008; 90: 226-32.




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