Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: Prospective cohort study

Rev Esp Cir Ortop Traumatol. 2017 Jul-Aug;61(4):259-264. doi: 10.1016/j.recot.2017.04.001. Epub 2017 Jun 20.
[Article in English, Spanish]

Abstract

Objective: Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection.

Material and method: Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model.

Results: The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05).

Discussion: Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence.

Conclusions: Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate.

Keywords: Antibiotic prophylaxis; Artroplastia de rodilla; Infección del sitio quirúrgico; Knee arthroplasty; Profilaxis antibiótica; Surgical wound infection.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis / statistics & numerical data*
  • Arthroplasty, Replacement, Knee*
  • Enterococcus faecalis
  • Escherichia coli Infections / epidemiology
  • Escherichia coli Infections / etiology
  • Escherichia coli Infections / prevention & control
  • Female
  • Follow-Up Studies
  • Gram-Positive Bacterial Infections / epidemiology
  • Gram-Positive Bacterial Infections / etiology
  • Gram-Positive Bacterial Infections / prevention & control
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Preoperative Care*
  • Prospective Studies
  • Risk Adjustment
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / prevention & control
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents