Abstract
Introduction: Infection remains the single most important complication in elective joint replacement. 1.1% of patients suffer early deep infection and 10–17% of patients superficial infection [1]. Antibiotic prophylaxis has been used extensively in elective orthopaedic practice, approximately halving the post-operative infection rate [2]. Cefuroxime is almost universally used in the UK. However there is an increased incidence of multiple drug resistant bacteria within the environment in addition cephalosporin use and resistance is widespread [3]. Many patients are treated pre-operatively for urinary tract infections with cephalosporins, and a further group of patients are already colonised with cephalosporin resistant staphylococcus. We have previously shown that 8.1% of patients fall into one or other of these categories.
Methods: We present a prospective series of 630 serial elective orthopaedic admissions from all orthopaedic disciplines. We have examined notes and reviewed lab records in order to determine outcomes. The centre for disease control [4] definition was used for suspected infections, and confirmed with wound swabs. 48 cases were confirmed infectious from a suspected 142 cases meeting this definition.
Results: We found a positive correlation between previous urine infection, MRSA status, revision surgery, and diabetes and wound infection. Nearly 35% of bacterium cultured were cephalosporin resistant, and 12% demonstrated multiple antibiotic resistance.
Discussion: It is good clinical practice to provide antibiotic prophylaxis in joint replacement, but the blind use of cephalosporins in all patients does not make sense because of increased incidence of antibiotic resistant bacteria. We present evidence based guidelines for the use of antibiotic prophylaxis in elective orthopaedic surgery and empirical antibiotic treatment in patients with wound infection before culture results are available.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
References:
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