Deep surgical site infections following double-dose perioperative antibiotic prophylaxis in adult obese orthopedic patients

Abstract

Background: Obesity is a risk factor for surgical site infections (SSI). Based on retrospective comparisons and pharmacology, many orthopedic centers have adopted weight-or body mass index (BMI)-related antibiotic prophylaxis. Methods: Double-dose prophylaxis was introduced in March 2017 for patients weighting >80 kg. The period April 2014 to March 2017 ('before') was compared to the period March 2017 to June 2019 ('after') regarding the impact on deep SSIs. Results: A total of 9318 surgeries 'before' were compared to 7455 interventions 'after' the introduction of double-dose prophylaxis. Baseline demographic characteristics (age, sex, BMI, American Society of Anesthesiologists score, and duration of surgery) were similar. In the period 'after', 3088 cases (3088/16 773; 18%) received double-dose prophylaxis. Overall, 82 deep SSIs were observed (0.5%). The pathogens were resistant to the standard cefuroxime prophylaxis in 30 cases (30/82; 37%). Excluding these prophylaxis-resistant cases and all of the five hematogenous SSIs, the remaining 47 SSIs (57%) could have been prevented by the preceding prophylaxis. Double-dosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients did not reduce deep SSIs (hazard ratio 0.7, 95% confidence interval 0.3-1.6). In the direct group comparison among obese patients >80 kg, the double-dose prophylaxis equally failed to alter the SSI risk (3088/16 726 non-infections vs 8/47 SSI despite double-dose prophylaxis; Chi-square test, P = 0.78). Conclusions: In this single-center before-and-after study with almost 17 000 orthopedic surgeries in adult patients, systemic doubling of the perioperative antibiotic prophylaxis in obese patients clinically failed to reduce the overall deep SSI risk.

Wound Healing in Diabetic Patients

“…Infection will lead to painful wound, a sign which should be carefully evaluated especially in diabetic patients. In our study 71.67% had pain on wounds while 28.33% did not had painful wound [19][20][21] . Swelling around the wound is expected initially but if it is associated with un-usual pain or fail to subside over certain time period, infection must be ruled out 22,23 .…”

Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis

“…We assessed the accuracy of the perioperative antibiotic prophylaxis at our institution for another concomitant study [ 15 ] by retrospectively controlling all SSI in the medical files. According to this analysis, a correct antibiotic prophylaxis including its timing occurred in 98% in all three study periods [ 15 ]. The HCW' staffing level was more than adequate ( data not shown ).…”

General Skin and Nasal Decolonization with octenisan® Set before and after Elective Orthopedic Surgery in Selected Patients at Elevated Risk for Revision Surgery and Surgical Site Infections - A Single-Center, Unblinded, Superiority, Randomized-Controlled Trial (BALGDEC Trial)

“…On the other hand, many clinics succeeded to lower their incidence of SSI due to MRSA (or S. aureus) in orthopedic surgery by classical infection control measures (or spontaneously); without implementing decolonization [17]. Today, in many centers, the largest nosocomial pathogen group in orthopedic surgery are skin commensals other than S. aureus [11,12,15,40].…”

“…As S. epidermidis is part of the normal human ora [13], a presurgical screening is not feasible, because everyone is colonized with CoNS in general, and with S. epidermidis in particular [13]. Unsurprisingly, with so much natural methicillin-resistance, the prophylaxis-resistant part of all SSIs is 30-50% [14,15].…”