HIP FRACTURE ANTIBIOTIC PROPHYLAXIS: THREE DOSE CEFUROXIME REGIME VERSUS SINGLE DOSE GENTAMICIN AND AMOXICILLIN

Abstract

Antibiotic prophylaxis aims to reduce wound and prosthetic infection, with minimal adverse effects. The 3 dose Cefuroxime regime is widely used, despite the risk of infective diarrhoea. We describe the results of single dose intraoperative Gentamicin and Amoxicillin compared to this standard regime.

We retrospectively reviewed 220 patients following hip hemiarthroplasty, creating 2 demographically matched cohorts; Group 1: 3 doses of Cefuroxime (n=113) and Group 2: single dose Gentamicin and Amoxicillin (n=107). End points were evidence of infection, length of stay and Clostridium difficile (CD) rates. results showed a significant reduction in group 2 for average length of stay (17 Vs. 13 days p=0.0432) and CD rates (7/113 Vs 0/107 p=0.0158).

Considering antibiotic therapies administered; significant reductions in group 2 for the number of patients that required post-operative antibiotics (99/113 Vs 73/107 p=0.0005), the median antibiotic DDDs (Defined Daily Doses) in 1st 2 post-operative days (0.25 Vs 0 p=0.0000) and those that received Ciprofloxacin or Cefuroxime post-operatively (82/113 Vs 24/107 p=0.0000). No significant difference was found for median antibiotic DDDs, median antibiotic DDDs from 2nd post-operative day, patients that received Flucloxacillin post-operatively.

Measured microbiological outcomes showed a significant reduction in the number of patients with confirmed growth requiring treatment with antibiotics in group 2 (21/23 Vs 12/22 p=0.0053). No difference was found between number patients with operation site swabbed and those with confirmed microbial growth.

We demonstrate single dose Gentamicin and Amoxicillin significantly reduces length of stay, CD rates and the number of patients requiring post-operative antibiotics for wound infection, inferring a reduction in the rate of wound infection. We would recommend this as an effective alternative to the 3 dose Cefuroxime regime.