Archive for September 18, 2016

Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

CMAJ Open. 2015 Jul 17; V.3 N.3 E338-43.

Thornley P1, Evaniew N1, Riediger M1, Winemaker M1, Bhandari M1, Ghert M1.

Author information

1Faculty of Health Sciences (Thornley), Michael G. DeGroote School of Medicine; Division of Orthopaedics (Evanview, Riediger, Winemaker, Bhandari, Ghert), Department of Surgery; Department of Clinical Epidemiology and Biostatistics (Bhandari), McMaster University, Hamilton, Ont.

Abstract

BACKGROUND:

Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections.

METHODS:

We systematically searched MEDLINE, Embase and the Cochrane Library for randomized controlled trials (RCTs) published up to Aug. 15, 2014. We included all RCTs that compared postoperative antibiotic prophylaxis with postoperative placebo or no treatment in patients undergoing primary total hip or knee arthroplasty for osteoarthritis. We combined outcomes for surgical-site infection using a random-effects model and quantified heterogeneity using the χ2 test and the I2 statistic. We assessed the overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS:

We identified 4 RCTs (n = 4036) that met the inclusion criteria. Surgical-site infections occurred in 3.1% (63/2055) of patients in the prophylaxis group and 2.3% (45/1981) in the control group. Postoperative prophylaxis did not reduce the rate of surgical-site infections compared with placebo (risk difference 0.01, 95% confidence interval 0.00 to 0.02; I2 = 26%). This result was robust to sensitivity testing for losses to follow-up. According to the GRADE approach, the overall quality of evidence was very low.

INTERPRETATION:

The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596117/pdf/cmajo.20150012.pdf

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September 18, 2016 at 4:41 pm

Antibiotic prophylaxis to prevent surgical site infections.

Am Fam Physician. March 1, 2011 V.83 N.5 P.585-90.

Salkind AR1, Rao KC.

Author information

1University of Missouri-Kansas City School of Medicine, MO 64108, USA. salkinda@umkc.edu

Abstract

Surgical site infections are the most common nosocomial infections in surgical patients, accounting for approximately 500,000 infections annually. Surgical site infections also account for nearly 4 million excess hospital days annually, and nearly $2 billion in increased health care costs.

To reduce the burden of these infections, a partnership of national organizations, including the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention, created the Surgical Care Improvement Project and developed six infection prevention measures.

Of these, three core measures contain recommendations regarding selection of prophylactic antibiotic, timing of administration, and duration of therapy.

For most patients undergoing clean-contaminated surgeries (e.g., cardiothoracic, gastrointestinal, orthopedic, vascular, gynecologic), a cephalosporin is the recommended prophylactic antibiotic. Hospital compliance with infection prevention measures is publicly reported.

Because primary care physicians participate in the pre- and postoperative care of patients, they should be familiar with the Surgical Care Improvement Project recommendations.

FULL TEXT

http://www.aafp.org/afp/2011/0301/p585.html

PDF

http://www.aafp.org/afp/2011/0301/p585.pdf

September 18, 2016 at 4:40 pm


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