No abstract

Objective: Investigation of the bacteriological quality of processed wound blood in orthopedic hip surgery depending on antibiotic prophylaxis or not. Design: Prospective randomized study after approval of the Ethics Committee. Setting: Operation theatre/intensive care unit of an Orthopedic University Clinic. Patients: 40 patients underwent first hip arthroplasty under regional anesthesia. 20 received as antibiotic prophylaxis cefuroxime 1.5 g single shot, 20 not. Interventions: Preopera-tive collection of autologous plasma (2 × 900 ml), normovolemic hemodilution (15 ml/KG), intra- and postoperative mechanical autotransfusion (Cell Saver®/Autotrans®). A quantitative bacteriological study was performed from the collecting bag (Vacufix®), wound drainage blood and processed red blood cell concentrates (PRBCC), using a pour plate technique and broth culture enrichment (Bactec® bottles). Examination after 2 and 7 days. Results: Maximally 1 CFU/ml (colony-forming unit) of bacteria was isolated from 8 Vacufix® bags of the control group (8/20), in contrast to no growth in the antibiotic group (0/20; p < 0.005). Wound drainage blood was found sterile in all patients. In 8 PRBCC of the control group (8/20) bacteria were identified in a concentration of < l (5×), 1-2 (2×), and 130 (l×) CFU/ml. In the cefuroxime group only 3/20 showed bacterial growth < l CFU/ml. Conclusions: Bacterial contamination of processed wound blood never caused wound or systemic infections. Antibiotic prophylaxis (cefuroxime) led to sterility in the Vacufix® collecting bac and reduction of bacterial growth in the PRBCC.