The effect of changing antibiotic prophylaxis on surgical site infection following proximal femoral fracture surgery

Abstract Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

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Implementing 1-Dose Antibiotic Prophylaxis for Prevention of Surgical Site Infection—Invited Critique

Archives of Surgery ◽

10.1001/archsurg.141.11.1114 ◽

2006 ◽

Vol 141 (11) ◽

pp. 1114

Author(s):

Martin A. Makary

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Site Infection

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Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin Fails to Improve Inguinal Surgical Site Infection Rate After Vascular Surgery

Vascular and Endovascular Surgery ◽

10.1177/1538574415600531 ◽

2015 ◽

Vol 49 (5-6) ◽

pp. 129-134 ◽

Cited By ~ 6

Author(s):

Julien Hasselmann ◽

Tobias Kühme ◽

Stefan Acosta

Keyword(s):

Vascular Surgery ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Infection Rate ◽

Site Infection ◽

Surgical Site Infection Rate

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C-reactive protein levels for early detection of early postoperative complications after proximal femoral fracture surgery

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-017-2080-z ◽

2017 ◽

Vol 28 (5) ◽

pp. 907-913 ◽

Cited By ~ 2

Author(s):

Romain Schutz ◽

Baptiste Boukebous ◽

Pierre Boutroux ◽

Pascal Guillon

Keyword(s):

Postoperative Complications ◽

Early Detection ◽

Femoral Fracture ◽

Proximal Femoral Fracture ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Early Postoperative Complications ◽

Fracture Surgery

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Surgical Site Infection in Hip Fracture Surgery; Reducing the Incidence of Infection and Correlation With co Morbidities and Blood Parameters

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2018.05.238 ◽

2018 ◽

Vol 5 (2) ◽

pp. 891-895 ◽

Cited By ~ 1

Author(s):

Shaik Yousufuddin ◽

◽

Mubasher A Latif ◽

Chaudhry Samena ◽

S. A. Ali ◽

...

Keyword(s):

Hip Fracture ◽

Surgical Site Infection ◽

Blood Parameters ◽

Site Infection ◽

Hip Fracture Surgery ◽

Fracture Surgery

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Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700075305 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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