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The effectiveness and safety of two prophylactic antibiotic regimes in hip-fracture surgery

  • Original Article • HIP - TRAUMA
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Abstract

Antibiotic prophylaxis with cefuroxime can reduce the incidence of deep wound infection (DWI) in hip-fracture surgery, but may increase the risk of C. difficile infection (CDI). An alternative is gentamicin with beta-lactam for which a question exists around clinical effectiveness and safety, given the gentamicin-associated nephrotoxicity particularly in the elderly and narrower sensitivity spectrum. We compared 744 consecutive patients (group I—cefuroxime) with 756 in group II (gentamicin + flucloxacillin) who were well matched. There were 4 cases of CDI in the cefuroxime prophylaxis, whereas none in flucloxacillin plus gentamicin (group II). There was a statistically significant (p = 0.036) increased DWI rate in group II (2.5 %) as compared to group I (1.1 %). However, after controlling for age, gender, ASA grade, surgeon grade, implant type and type of anaesthesia, there was no statistically significant difference between the two groups (p = 0.146). 8.5 % of group I and 16.5 % of group II developed AKI post-operatively (p = 0.023); however, 79 % of group I and 80 % of in group II had complete resolution of AKI prior to their discharge. Further, a significant increase in inpatient deaths (p = 0.057) in group II was observed, but not at 30 days (p = 0.378).

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Authors and Affiliations

  1. Department of Anaesthesia and Critical Care, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK

    Iftikhar Ahmed

  2. Department of Trauma and Orthopaedic Surgery, Hull Royal Infirmary, Hull, UK

    M. A. Khan & A. Mohsen

  3. Senior Medical Statistician, Hull and York Medical School, University of Hull, Hull, UK

    V. Allgar

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  1. Iftikhar Ahmed
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  2. M. A. Khan
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  3. V. Allgar
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  4. A. Mohsen
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Correspondence to Iftikhar Ahmed.

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Ahmed, I., Khan, M.A., Allgar, V. et al. The effectiveness and safety of two prophylactic antibiotic regimes in hip-fracture surgery. Eur J Orthop Surg Traumatol 26, 483–492 (2016). https://doi.org/10.1007/s00590-016-1794-7

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  • DOI: https://doi.org/10.1007/s00590-016-1794-7

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