scholarly journals The Impact of Timing, Selection, and Dosage of Preoperative Prophylactic Antibiotics on Preventable Surgical Site Infections

2012 ◽  
Author(s):  
Cathy Insana
Keyword(s):  
Knee Arthroplasty ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Tissue Perfusion ◽  
Prophylactic Antibiotics ◽  
Hospital Charges ◽  
Antibiotic Administration ◽  
Surgical Incision ◽  
Total Hip ◽  
The Impact

<p>Surgical site infections (SSIs) are a subset of a larger group of infections that are known as hospital acquired infections (HAis). SSIs are a huge financial burden, costing billions of dollars in excess hospital charges every year. There is a considerable amount of evidence-based practice recommendations that can help reduce the incidence of SSIs. Research has supported the efficacy of preoperative antibiotic prophylaxis when appropriately selected and timed according to published guidelines. In addition to these measures, re-dosing of antibiotics must occur for those procedures that last more than four hours in order to continue to maintain tissue perfusion throughout the surgical procedure. The purpose of this study was to evaluate the timely administration, appropriate selection, and dosage of preoperative prophylactic antibiotics in surgical patients in one community hospital. A retrospective research design was used to obtain information on 100 randomly selected colon, hysterectomy, total hip and knee arthroplasty cases. Data were collected on those surgical procedures that occurred between October 1, 2010 and March 31 , 2011. During this time period, there were eight documented SSIs, three involving an organ space, and five that were superficial. In more than half of the colon and hysterectomy cases, the prophylactic antibiotic was administered less than 30 minutes before surgical incision, and in more than half of the total hip and total knee arthroplasty cases, antibiotic administration was between 30-60 minutes. All the procedures met the SCIP recommendations for timing and selection of prophylactic antibiotic. This study suggests that to ensure adequate tissue perfusion prior to surgical incision, the antibiotic should be administered in the preoperative holding unit, immediately prior to transfer to the operating room. This would assure that the antibiotic is given 30-60 minute timeframe, thus reducing the potential for the development of a SSI. Recommendations for further research and advanced nursing practice are discussed.</p>

scholarly journals Perioperative antimicrobial prophylaxis in patients receiving antibiotic therapy

2021 ◽  
Author(s):  
Yiwei Yin ◽  
Eljim P Tesoro ◽  
Alan E Gross ◽  
Jeffery J Mucksavage
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Antimicrobial Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Dose Interval ◽  
Prophylactic Antibiotics ◽  
Antibiotic Administration

Objective: Antimicrobial prophylaxis is administered perioperatively to prevent surgical site infections. However, in patients who have already received antibiotics for the treatment of active infections prior to surgery, the risks and benefits of administering prophylactic antibiotics are unknown. We aimed to assess the necessity of perioperative prophylactic antibiotic administration in patients receiving antibiotic treatment for active infections. Method: This was a retrospective, chart-review cohort study. Between January 2018 to May 2018, adult patients who underwent inpatient surgery at the University of Illinois Hospital and Health Sciences System, and were prescribed prophylactic antibiotics based on institutional protocol, while receiving antibiotic treatment within 48 hours prior to surgery, were included in the study. The primary endpoint was the rate of duplicative antibiotic therapy, which was defined as the administered prophylactic antibiotic (1) exhibiting similar or narrower bacterial coverage as the treatment antibiotic(s), and (2) given within the dose interval of the treatment antibiotic(s). Results: A total of 158 patients were included in the study, of which 70 (44.3%) received duplicative antibiotic therapy, whereas 88 (55.7%) did not. Differences in the incidence of acute kidney injury, C. difficile infection, and surgery site infections were not statistically significant between the two groups. Conclusion We found that it was common for patients receiving therapeutic systematic antibiotics to perioperatively be prescribed additional prophylactic antibiotics at our institution. However, additional prophylactic antibiotics can be unnecessary in decreasing the incidence of surgical site infections.

scholarly journals Validation of an algorithm for semiautomated surveillance to detect deep surgical site infections after primary total hip or knee arthroplasty—A multicenter study

2020 ◽  
Vol 42 (1) ◽  
pp. 69-74
Author(s):  
Janneke D. M. Verberk ◽  
Stephanie M. van Rooden ◽  
Mayke B. G. Koek ◽  
David J. Hetem ◽  
Annelies E. Smilde ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
High Probability ◽  
Surgical Site Infections ◽  
Data Interpretation ◽  
Routine Care ◽  
Successful Implementation ◽  
Subjective Data ◽  
Essential Information ◽  
Total Hip ◽  
Healthcare Associated

AbstractObjective:Surveillance of healthcare-associated infections is often performed by manual chart review. Semiautomated surveillance may substantially reduce workload and subjective data interpretation. We assessed the validity of a previously published algorithm for semiautomated surveillance of deep surgical site infections (SSIs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Dutch hospitals. In addition, we explored the ability of a hospital to automatically select the patients under surveillance.Design:Multicenter retrospective cohort study.Methods:Hospitals identified patients who underwent THA or TKA either by procedure codes or by conventional surveillance. For these patients, routine care data regarding microbiology results, antibiotics, (re)admissions, and surgeries within 120 days following THA or TKA were extracted from electronic health records. Patient selection was compared with conventional surveillance and patients were retrospectively classified as low or high probability of having developed deep SSI by the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction were calculated and compared to conventional surveillance.Results:Of 9,554 extracted THA and TKA surgeries, 1,175 (12.3%) were revisions, and 8,378 primary surgeries remained for algorithm validation (95 deep SSIs, 1.1%). Sensitivity ranged from 93.6% to 100% and PPV ranged from 55.8% to 72.2%. Workload was reduced by ≥98%. Also, 2 SSIs (2.1%) missed by the algorithm were explained by flaws in data selection.Conclusions:This algorithm reliably detects patients with a high probability of having developed deep SSI after THA or TKA in Dutch hospitals. Our results provide essential information for successful implementation of semiautomated surveillance for deep SSIs after THA or TKA.

scholarly journals Determinants of return to work 12 months after total hip and knee arthroplasty

2016 ◽  
Vol 98 (6) ◽  
pp. 387-395 ◽  
Author(s):  
CS Leichtenberg ◽  
C Tilbury ◽  
PPFM Kuijer ◽  
SHM Verdegaal ◽  
R Wolterbeek ◽  
...  
Keyword(s):  
Return To Work ◽  
Knee Arthroplasty ◽  
Total Hip ◽  
Self Employment ◽  
Outcome Score ◽  
Number Of Patients ◽  
Modifiable Factors ◽  
Absence From Work ◽  
The Impact ◽  
Type Of Surgery

Introduction A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA. Methods We conducted a prospective, observational study of working patients aged <65 years undergoing THA or TKA for osteoarthritis. The primary outcome was full versus partial or no return to work 12 months postoperatively. Factors analysed included preoperative sociodemographic and work characteristics, alongside the Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Hip and Knee Scores. Results Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work. Conclusions In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately.

scholarly journals Acute kidney injury following prophylactic flucloxacillin and gentamicin in primary hip and knee arthroplasty

2020 ◽  
Author(s):  
Judi Graham ◽  
Emma Borthwick ◽  
Christopher Hill ◽  
Janine Blaney ◽  
Nicola Gallagher ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Knee Arthroplasty ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Surgical Site Infections ◽  
Ideal Body Weight ◽  
High Dose ◽  
Binary Logistic Regression Model ◽  
Hip And Knee Arthroplasty

Abstract Background Following concerns regarding the emergence of Clostridium difficile infection in 2010, we changed antibiotic prophylaxis in patients undergoing primary hip and knee arthroplasty from cefuroxime to flucloxacillin and single-dose (SD) gentamicin. A subsequent perceived increase in the incidence of post-operative acute kidney injury (AKI) led us to evaluate the AKI incidence between different prophylactic antibiotic regimes used at our centre. Methods We examined the incidence of AKI as defined by Kidney Disease: Improving Global Outcomes criteria in 1588 patients undergoing primary hip or knee arthroplasty from January 2010 to January 2015. Patients received the following prophylactic antibiotic regimes: 8 g flucloxacillin in four divided doses and SD gentamicin 1.5 mg/kg ideal body weight (IBW; maximum dose 120 mg; n = 400), 8 g flucloxacillin alone in four divided doses (n = 400), SD cefuroxime (n = 400), triple-dose (TD) cefuroxime (n = 188) and teicoplanin with SD gentamicin 1.5 mg/kg IBW (n = 200). Results The incidence of AKI was as follows: flucloxacillin and gentamicin (13%); flucloxacillin alone (8.5%); SD cefuroxime (2%); TD cefuroxime (0.5%); and teicoplanin and gentamicin (3%). Of the six patients who developed Stage 3 AKI, all were in the flucloxacillin and gentamicin group. The odds ratio for the development of AKI derived from a binary logistic regression model was highest in the flucloxacillin and gentamicin group [7.79 (95% confidence interval 3.54–17.14), P &lt; 0.0001]. Conclusions Our findings suggest that the use of prophylactic high-dose flucloxacillin and gentamicin should be used with caution in patients undergoing primary hip or knee arthroplasty without a clear advantage in reducing surgical site infections given the association with increased rates of AKI.

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

2019 ◽  
Vol 33 (02) ◽  
pp. 100-105 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Aldo M. Riesgo ◽  
Preetesh D. Patel ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Postoperative Infection ◽  
Prophylactic Antibiotic ◽  
The United States ◽  
Prophylactic Antibiotics ◽  
Infection Rates ◽  
Mrsa Infection ◽  
Total Knee

AbstractThe risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

Ceforanide vs. Cephalothin Concentrations in Total Joint Arthroplasty

1983 ◽  
Vol 17 (9) ◽  
pp. 645-648 ◽  
Author(s):  
William J. Cady ◽  
Bradley G. Wulf ◽  
Michael T. O'Neil ◽  
Dwight W. Burney ◽  
William R. Hamsa
Keyword(s):  
Total Knee Arthroplasty ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Plasma Concentrations ◽  
Prophylactic Antibiotic ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Orthopedic Procedure ◽  
Total Knee

Total joint arthroplasty is a common orthopedic procedure and requires prophylactic antibiotic coverage to prevent infections in the operated joint. The antibiotics routinely used for prophylaxis are the cephalosporins. This study compared bone, synovial fluid, and plasma concentrations of ceforanide with cephalothin concentrations in 30 patients undergoing elective total hip or total knee arthroplasty. Ceforanide provided significantly higher plasma concentrations for 61–110 minutes postdose than did cephalothin (p < 0.025 and p < 0.005). No difference was noted between the two antibiotics for the bone concentrations in the total hip arthroplasty group; however, cephalothin concentrated to a greater degree in the bone of patients undergoing total knee arthroplasty (p < 0.05). Cephalothin achieved higher concentrations in the synovial fluid than did ceforanide (p < 0.05). Both antibiotics were well tolerated and no postoperative infections were noted in either group.

The Impact of Diabetes on Perioperative Patient Outcomes after Total Hip and Total Knee Arthroplasty in the United States

2008 ◽  
Vol 23 (2) ◽  
pp. 322-323
Author(s):  
Michael P. Bolognesi ◽  
Milford H. Marchant, Jr. ◽  
Nicholas A. Viens ◽  
Chad Cook ◽  
Ricardo Pietrobon ◽  
...  
Keyword(s):  
United States ◽  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
The United States ◽  
Total Hip ◽  
Total Knee ◽  
The Impact

Evaluation of postdischarge surveillance of surgical site infections after total hip and knee arthroplasty

2005 ◽  
Vol 33 (8) ◽  
pp. 455-462 ◽  
Author(s):  
Frank Huenger ◽  
Adriane Schmachtenberg ◽  
Helga Haefner ◽  
Dirk Zolldann ◽  
Katharina Nowicki ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

scholarly journals Relationship Between Staphylococcus aureus Carriage and Surgical Site Infections Following Total Hip and Knee Arthroplasty in the South Asian Population: Protocol for a Prospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Syed H Mufarrih ◽  
Nada Q Qureshi ◽  
Anum Sadruddin ◽  
Pervaiz Hashmi ◽  
Syed Faisal Mahmood ◽  
...  
Keyword(s):  
South Asian ◽  
Knee Arthroplasty ◽  
Surgical Site Infections ◽  
Asian Population ◽  
University Hospital ◽  
The South ◽  
South Asian Population ◽  
Methicillin Resistant ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

BACKGROUND Surgical site infections following total hip or knee arthroplasties have a reported rate of 0.49%-2.5% and can cause significant morbidity as well as tripling the cost of health care expenses. Both methicillin sensitive and methicillin resistant strains of Staphylococcus aureus surgical site infections have been established as a major risk factor for postoperative surgical site infections. S. aureus colonizes the nose, axillae, and perineal region in up to 20%-30% of individuals. Although the literature has reported a higher prevalence of methicillin resistant S. aureus in the South Asian population, routine preoperative screening and prophylaxis have not yet been implemented. OBJECTIVE The primary objective of our study is to identify the relationship between preoperative colonization status of S. aureus and incidence of postoperative surgical site infections in patients undergoing following total hip and knee arthroplasties. As part of the secondary objectives of this study, we will also investigate patient characteristics acting as risk factors for S. aureus colonization as well as the outcomes of total hip and knee arthroplasty patients which are affected by surgical site infections. METHODS This prospective cohort study will comprise of screening all patients older than 18 years of age admitted to the Aga Khan University Hospital for a primary total hip or knee arthroplasty for preoperative colonization with S. aureus. The patients will be followed postoperatively for up to one year following the surgery to assess the incidence of surgical site infections. The study duration will be 2 years (March 2018 to March 2020). For the purpose of screening, pooled swabs will be taken from the nose, axillae, and groin of each patient and inoculated in a brain heart infusion, followed by subculture onto mannitol salt agar and sheep blood agar. For methicillin resistant S. aureus identification, a cefoxitin disk screen will be done. Data will be analyzed using SPSS v23 and both univariate and multivariate regression analysis will be conducted. RESULTS Data collection for this study will commence at the Aga Khan University Hospital, Pakistan during March 2018. CONCLUSIONS This study will not only estimate the true burden caused by S. aureus in the population under study but will also help identify the patients at a high risk of surgical site infections so that appropriate interventions, including prophylaxis with antibiotics such as muciprocin ointment or linezolid, can be made. Given the differences in lifestyle, quality, and affordability of health care and the geographical variation in patterns of antibiotic resistance, this study will contribute significantly to providing incentive for routine screening and prophylaxis for S. aureus including methicillin resistant S. aureus colonization in the South Asian population. REGISTERED REPORT IDENTIFIER RR1-10.2196/10219

The Impact of Preoperative Education on Patients Undergoing Elective Total Hip and Knee Arthroplasty

2020 ◽  
Vol 39 (4) ◽  
pp. 218-224
Author(s):  
Julie L. Giardina ◽  
Katrina Embrey ◽  
Kathy Morris ◽  
Helen M. Taggart
Keyword(s):  
Knee Arthroplasty ◽  
Preoperative Education ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
The Impact
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