Journal Article

Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

Marjo E. E. van Kasteren, Judith Manniën, Alewijn Ott, Bart-Jan Kullberg, Annette S. de Boer and Inge C. Gyssens

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 7, pages 921-927
Published in print April 2007 | ISSN: 1058-4838
Published online April 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/512192
Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

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Background. Surgical site infections (SSIs) following total hip arthroplasty can lead to prolonged hospitalization, increased morbidity and mortality, and high costs. This article analyzes the effect of various parameters of surgical antibiotic prophylaxis on the risk of SSI following total hip arthroplasty.

Methods. Data about SSI and potential prophylaxis-, patient-, and procedure-related risk factors were prospectively collected for 1922 patients who underwent elective total hip arthroplasty in 11 hospitals that participated in the Dutch intervention project, Surgical Prophylaxis and Surveillance. Multivariate logistic regression analysis was performed to correct for random variation among hospitals.

Results. SSIs (superficial and deep) occurred in 50 patients (2.6%). The highest odds ratios for SSI were found in patients who received prophylaxis after incision (2.8, 95% confidence interval [CI], 0.9–8.6; P = .07), had an American Society of Anesthesiology score that was >2 (2.8, 95% CI, 0.8–9.2; P = .09), and experienced a duration of surgery that was >75th percentile (2.5; 95% CI, 1.1–5.8; P = .04). Prolonged prophylaxis after the end of surgery and the use of antibiotic-impregnated cement did not contribute to fewer SSIs in this study.

Conclusions. This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis.

Journal Article.  4572 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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