Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Modha, Ravi Krishān; Morriss-Roberts, Chris; Smither, Madeleine; Larholt, Jonathan; Reilly, Ian

doi:10.1186/s13047-018-0303-0

Cited by 26 publications

(18 citation statements)

References 37 publications

(147 reference statements)

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“…A Cochrane review revealed that the use of antibiotics has not been shown to result in a difference in infection rates [22]. Using a similar dataset, a prospective cohort study by Butterworth et al [11] showed that the use of perioperative antibiotics in foot and ankle surgery may reduce the risk of infection. However, Butterworth et al [11] did not separate their study population into specific procedure groups.…”

Section: Discussionmentioning

confidence: 99%

“…Using a similar dataset, a prospective cohort study by Butterworth et al [11] showed that the use of perioperative antibiotics in foot and ankle surgery may reduce the risk of infection. However, Butterworth et al [11] did not separate their study population into specific procedure groups. Consequently, whether antibiotic prophylaxis reduces infection rates following ingrowing toenail surgery may be unclear.…”

Section: Discussionmentioning

confidence: 99%

“…This tool was developed by an international panel of experts to assess outcomes of foot and ankle surgery. The design, purpose, and method through which surgeons enter data into this tool has been previously described [8,[10][11][12].…”

Section: Data Collectionmentioning

confidence: 99%

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Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study

Terrill

Green

Salerno³

et al. 2020

Journal of Foot and Ankle Research

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Background: Ingrowing toenails are a common and painful condition often requiring surgical management. Practitioners who perform surgery on ingrowing toenails include orthopaedic surgeons, general practitioners, podiatrists and podiatric surgeons. There has been limited investigation into the specific surgical approaches used by Australian podiatric surgeons for ingrowing toenails, or the associated infection rates for these procedures. The aim of this study was to assess the frequency and type of ingrowing toenail surgery performed by podiatric surgeons, and identify risk factors for post-operative infection. Methods: Data was entered into the Australian College Podiatric Surgeons (ACPS) National Audit Tool for all patients who underwent foot and ankle surgery performed by podiatric surgeons in Australia between January 2014 and December 2017. Infection within the first 30 days following surgery was recorded according to the ACPS national audit descriptors. Infection rates, risk ratios (RR) and 95% Confidence Intervals (CI) were calculated to determine postoperative infection risk. Results: Of 7682 records, 1831 reported 2712 diagnoses of ingrowing nails. Patients with a diagnosis of ingrowing toenails were younger, less likely to have systemic disease, and a lower proportion were female compared to those without ingrowing toenails. Furthermore, they were more likely to be diagnosed with a post-operative infection than those without ingrowing toenails (RR = 2.72; CI = 2.00-3.69; P < 0.01). Univariate risk factors for post-operative infection following ingrowing toenail surgery include age greater than 60 years (RR = 3.16; CI = 1.53-6.51; P < 0.01), surgery performed in an office setting (RR = 1.77; CI = 1.05-2.98; P = 0.04), and radical excision of toenail bed procedure (RR = 2.35; CI = 1.08-5.01; P = 0.04). Patients that underwent radical excision or office based procedures were on average older, and more likely to have systemic disease. Further, radical excision procedures were more likely to be performed in office base settings. Conclusions: Ingrowing toenail surgery carries a greater risk of postoperative infection than other procedures performed by podiatric surgeons. Radical excision of toenail bed was associated with higher postoperative infection rates compared to other ingrowing toenail procedures. Procedures performed in an office setting carry a higher risk of infection. Further research into these associations is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study

Terrill

Green

Salerno³

et al. 2020

Journal of Foot and Ankle Research

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“…Previously reported as pathogens of SSIs in foot and ankle surgery are S. aureus, Pseudomonas , and Staphylococcus epidermidis , all associated with the formation of a biofilm on foreign material. 13,15,21 Since cephalosporins are effective in preventing Staphylococcus infections, cefazolin is the most often used prophylactic antibiotic in a variety of surgical procedures and is recommended for implant surgery by multiple guidelines. 4,7 The most common pathogens causing SSI in this study were S. aureus and Enterobacter cloacae .…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee

et al. 2020

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Background: The rate of surgical site infections (SSIs) after foot or ankle surgery remains high, despite the implementation of antibiotic prophylaxis. Recently, guidelines suggest a single dose of 2 g instead of 1 g of cefazolin for implant surgery; this decision is largely based on pharmacokinetic studies. However, the clinical effect of this higher dose has never been investigated in foot and ankle surgery. This retrospective cohort study investigated the effect of 2 g compared with 1 g of prophylactic cefazolin on the incidence of SSIs in foot and ankle surgery. Methods: All patients undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 were included. The primary outcome was the incidence of an SSI. SSIs were compared between patients receiving 1 g and 2 g of cefazolin as surgical prophylaxis, using a propensity score to correct for possible confounders. Results: A total of 293 patients received 1 g and 126 patients received 2 g of cefazolin. The overall number of SSIs was 19 (6.5%) in the 1-g group and 6 (4.8%) in the 2-g group. Corrected for possible confounders, this was not statistically significant (OR, 0.770; P = .608). Conclusion: Even though the decrease in SSI rate from 6.5% to 4.8% was found not to be statistically significant, it might be clinically relevant considering the reduction in morbidity, mortality, and healthcare costs. Research linking pharmacokinetic and clinical results of prophylactic cefazolin is needed to establish whether or not the current recommendations and guidelines are sufficient for preventing SSIs in foot and ankle surgery. Level of Evidence: Level III, retrospective comparative series.

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“…The incidence of surgical site infections (SSIs) following orthopedic trauma surgery of foot and ankle has been reported as ranging from 0 to 9.4% [1]. In complex foot injuries, this percentage can even increase up to 25% [2].…”

Section: Introductionmentioning

confidence: 99%

Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

Sanders

Hul

Kistemaker

et al. 2020

Arch Orthop Trauma Surg

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Introduction Post-operative wound complications remain among the most common complications of orthopedic (trauma) surgery. Recently, studies have suggested environmental factors such as season to be of influence on wound complications. Patients operated in summer are reported to have more wound complications, compared to other seasons. The aim of this study was to identify if "seasonality" was a significant predictor for wound complications in this cohort of trauma-related foot/ankle procedures. Materials and methods This retrospective cohort study included all patients undergoing trauma-related surgery (e.g. fracture fixation, arthrodesis, implant removal) of the foot, ankle or lower leg. Procedures were performed at a Level 1 Trauma Center between September 2015 until March 2019. Potential risk factors/confounders were identified using univariate analysis. Procedures were divided into two groups: (1) performed in summer (June, July or August), (2) other seasons (September-May). The number of surgical wound complications (FRIs, SSIs or wound dehiscence) was compared between the two groups, corrected for confounders, using multivariate regression. Results A total of 599 procedures were included, mostly performed in the hindfoot (47.6%). Patients were on average 46 years old, and mostly male (60.8%). The total number of wound complications was 43 (7.2%). Age, alcohol abuse, open fracture and no tourniquet use were independent predicting factors. No difference in wound complications was found between summer and other seasons, neither in univariate analysis [4 (3.2%) vs 39 (8.2%), p = 0.086] nor when corrected for predicting factors as confounders (p = 0.096).Conclusions No seasonality could be identified in the rate of wound complications after trauma surgery of the lower leg, ankle and foot in this cohort. This lack of effect might result from the temperate climate of this cohort. Larger temperature and precipitation differences may influence wound complications to a larger extent. However, previous studies suggesting seasonality in wound complications might also be based on coincidence.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Cited by 26 publications

References 37 publications

Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study

Risk factors for infection following ingrowing toenail surgery: a retrospective cohort study

Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee

Seasonal effect on the incidence of post-operative wound complications after trauma-related surgery of the foot, ankle and lower leg

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