Regional intravenous versus systemic intravenous prophylactic administration of third-generation cephalosporins (ceftazidime and ceftriaxone) in elective foot surgery

Dounis, Eleftherios; Tsourvakas, Stefanos; Kalyvas, L.; Tzivelekis, P.; Papakalou, E.; Giamarellou, Helen

doi:10.1016/0958-2592(95)90005-5

Cited by 3 publications

(11 citation statements)

References 13 publications

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“… • This study used ASA 1 patients therefore findings are based on the assumption that an unremarkable medical history and peripheral vascular status, with adequate circulation will achieve the required concentration levels as serum concentration was not individually measured in this study. Study Name Dounis et al (1995) Prospective Cohort Study [ 21 ] Participants • 67 patients undergoing foot and ankle surgery with no hepatic/renal insufficiency, known allergies to cephalosporin/penicillin antibiotics or concurrent steroid/immunosuppressant/antibiotic therapy. • Procedures included: 10 ankle fusions, 7 triple arthrodesis of rearfoot, 12 Keller’s arthroplasties, 15 Chevron osteotomies, 16 Mitchell osteotomies and 7 metatarsal head excisions on patients ranging from 39 to 72 with a mean age of 58.9 years old ±9.2 (sd).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies prospectively evaluated antibiotic bone penetration, using the minimum inhibitory concentrations (MIC90) as a quantitative marker to demonstrate effectiveness against 90% of the most common causative organisms found in vitro at the site of surgery [ 20 , 21 ].…”

Section: Resultsmentioning

confidence: 99%

“…Grade of recommendation: A. Antibiotic prophylaxis should be delivered to the patient within 60 min of inflation of pneumatic tourniquet to allow sufficient plasma concentrations of the drug to be utilised [2–4, 18–22, 27, 28, 34–37]. Grade of recommendation: A.…”

Section: Discussionmentioning

confidence: 99%

“…In clean, uncomplicated and elective soft tissue surgery of the foot and ankle antibiotic prophylaxis is not routinely warranted [2–4, 18–22, 27, 28, 34–37].…”

Section: Discussionmentioning

confidence: 99%

“…With respect to this, the decision should ultimately be based upon surgeon preference, patient and surgical risk factors with pertinence to the amount and type of hardware and surgery required. It is the personal view of the author that until better research is established national guidelines be followed and chemoprophylaxis in this situation be provided [2–4, 18–22, 27, 28, 34–37]…”

Section: Discussionmentioning

confidence: 99%

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

Modha

Morriss-Roberts

Smither

et al. 2018

Journal of Foot and Ankle Research

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BackgroundWith the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.MethodologyA systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.ResultsOverall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.ConclusionWhilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In clean, uncomplicated and elective soft tissue surgery of the foot and ankle antibiotic prophylaxis is not routinely warranted [2–4, 18–22, 27, 28, 34–37].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Modha

Morriss-Roberts

Smither

et al. 2018

Journal of Foot and Ankle Research

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Comparative study of systemic intravenous and regional intravenous administration of prophylactic antibiotic in lower extremity orthopaedic surgery

Tsourvakas

Alexandropoulos

Efstathiou

et al. 2009

Eur J Orthop Surg Traumatol

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Use of regional administration of prophylactic antibiotics in total knee arthroplasty

Symonds

Parkinson

Hazratwala

et al. 2018

ANZ Journal of Surgery

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Prosthetic joint infection after total knee arthroplasty is an infrequent, yet serious complication. Antimicrobial prophylaxis plays an important role in reducing the rate of surgical site infections. To be effective as an antimicrobial prophylaxis, the serum, tissue and bone concentrations of the antibiotic must be greater than the target organism's minimum inhibitory concentration. As antibiotic resistance increases current intravenous prophylactic dosing has been shown to be subtherapeutic for some patients. Intravenous regional administration and intraosseous regional administration of prophylactic antibiotics are novel methods used to increase the antibiotic tissue concentrations, which may enhance the efficacy of prophylactic antibiotics in total knee arthroplasty. Currently, literature has shown both intravenous regional administration and intraosseous regional administration to be safe and effective techniques. However, there is no clinical evidence to show that it results in a reduction of prosthetic joint infection rates. This study summarizes the current knowledge base on the use of regional administration of prophylactic antibiotics in total knee arthroplasty.

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Regional intravenous versus systemic intravenous prophylactic administration of third-generation cephalosporins (ceftazidime and ceftriaxone) in elective foot surgery

Cited by 3 publications

References 13 publications

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

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

Comparative study of systemic intravenous and regional intravenous administration of prophylactic antibiotic in lower extremity orthopaedic surgery

Use of regional administration of prophylactic antibiotics in total knee arthroplasty

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