Abstract
Research in antimicrobial prophylaxis started in the 70’s when Miles and Burke [23] established that the efficacy of antibiotics in reducing the wound size after subcutaneous bacterial inoculation in a guinea pig model was associated with its administration during surgery or few hours after wound closing. By delaying the administration of antibiotics by only 3 or 4 hours, the resulting lesions were identical in size to those of animals not receiving antibiotic prophylaxis. Afterwards, this concept was confirmed in a large study including surgical procedures performed in 2847 patients [6]. Patients receiving antibiotics between 24 h and 2 h before surgery or 3 h after finishing surgery had an infection rate over 3%. The lower infection rate (0.6%) was observed among those patients who received the antibiotic just prior to the intervention. Once the precise moment for the administration was established, many other studies were conducted to identify the best antibiotic for different types of surgery and its optimal duration. The information from these studies could be summarized as follows: 1) the antibiotic chosen should cover the main contaminant flora present in the skin or mucosa disrupted by incision, 2) it is necessary to achieve high antibiotic concentrations during surgery, therefore, the best moment for antibiotic infusion is 15–30 minutes by intravenous route before starting surgery and 3) the administration of one preoperative dose of antibiotic is probably sufficient. The third point is still controversial and many international guidelines maintain an antibiotic prophylaxis during 24 h after surgery.
Keywords
- Total Knee Arthroplasty
- Surgical Site Infection
- Antibiotic Prophylaxis
- Femoral Neck Fracture
- Antimicrobial Prophylaxis
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg (Br) 77(2):250–253
Ainscow DA, Denham RA (1984) The risk of haematogenous infection in total joint replacements. J Bone Joint Surg (Br) 66(4):580–582
Barwell J, Anderson G, Hassan A et al (1997) The effects of early tourniquet release during total knee arthroplasty: a prospective randomized double-blind study. J Bone Joint Surg (Br) 79(2):265–268
Brandt CM, Sistrunk WW, Duffy MC et al (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24(5):914–919
Carlsson AK, Lidgren L, Lindberg L (1977) Prophylactic antibiotics against early and late deep infections after total hip replacements. Acta Orthop Scand 48(4):405–410
Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326(5):281–286
Curry S, Phillips H (2002) Joint arthroplasty, dental treatment, and antibiotics: a review. J Arthroplasty 17(1):111–113
Engesaeter LB, Lie SA, Espehaug B et al (2003) Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0–14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 74(6):644–651
Falcieri E, Vaudaux P, Huggler E et al (1984) Role of bacterial exopolymers and host factors on adherence and phagocytosis of Staphylococcus aureus in foreign body infection. J Infect Dis 155(3):524–531
Friedman RJ, Friedrich LV, White RL et al (1990) Antibiotic prophylaxis and tourniquet inflation in total knee arthroplasty. Clin Orthop Relat Res (260):17–23
Garcia S, Lozano ML, Gatell JM et al (1991) Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole. J Bone Joint Surg (Am) 73(7):1044–1048
Gatell JM, Garcia S, Lozano L et al (1987) Perioperative cefamandole prophylaxis against infections. J Bone Joint Surg (Am) 69(8):1189–1193
Gatell JM, Riba J, Lozano ML et al (1984) Prophylactic cefamandole in orthopaedic surgery. J Bone Joint Surg (Am) 66(8):1219–1222
Greif R, Akca O, Horn EP et al (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Engl J Med 342(3):161–167
Johnson DP (1987) Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee. J Bone Joint Surg (Br) 69(5):787–789
Kalmeijer MD, Coertjens H, Nieuwland-Bollen PM et al (2002) Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 35(4):353–358
Kalmeijer MD, Nieuwland-Bollen E, Bogaers-Hofman D et al (2000) Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol 21(5):319–323
Kluytmans JA, Wertheim HF (2005) Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections. Infection 33(1):3–8
Krizek TJ, Robson MC (1975) Evolution of quantitative bacteriology in wound management. Am J Surg 130(5):579–584
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334(19):1209–1215
Latham R, Lancaster AD, Covington JF et al (2001) The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 22(10):607–612
Mangram AJ, Horan TC, Pearson ML et al (1999) 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 27(2):97–132
Miles AA, MIiles EM, Burke J (1957) The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol 38(1):79–96
Mini E, Nobili S, Periti P (1997) Methicillin-resistant staphylococci in clean surgery. Is there a role for prophylaxis? Drugs 54(Suppl 6):39–52
Oishi CS, Carrion WV, Hoaglund FT (1993) Use of parenteral prophylactic antibiotics in clean orthopaedic surgery. A review of the literature. Clin Orthop Relat Res (296):249–255
Perl TM, Cullen JJ, Wenzel RP et al (2002). Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 346(24):1871–1877
Richardson JB, Roberts A, Robertson JF et al (1993) Timing of antibiotic administration in knee replacement under tourniquet. J Bone Joint Surg (Br) 75(1):32–35
Ridgeway S, Wilson J, Charlet A et al (2005) Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg (Br) 87(6):844–850
Soriano A, Popescu D, Garcia S et al (2006) Usefulness of teicoplanin for preventing methicillin-resistant Staphylococcus aureus infections in orthopedic surgery. Eur J Clin Microbiol Infect Dis 25(1):35–38
Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351(16):1645–1654
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Soriano, A., García-Ramiro, S., Mensa, J. (2007). Antimicrobial Prophylaxis in Orthopaedic Surgery. In: Meani, E., Romanò, C., Crosby, L., Hofmann, G., Calonego, G. (eds) Infection and Local Treatment in Orthopedic Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-47999-4_6
Download citation
DOI: https://doi.org/10.1007/978-3-540-47999-4_6
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-47998-7
Online ISBN: 978-3-540-47999-4
eBook Packages: MedicineMedicine (R0)