Role of prophylactic antibiotics in lesser toe fusion surgery: A prospective randomised controlled trial

Mangwani, Jitendra; Gulati, A.; Benson, Rosalind; Cichero, Matthew; Williamson, David M.

doi:10.1016/j.fas.2016.02.004

Cited by 9 publications

(22 citation statements)

References 14 publications

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“…abstract only- high level of detail lacking. Study Name Mangwani et al (2016) Prospective RCT [ 27 ] Participants • 100 patients undergoing lesser toe fusion in which an external k-wire was to be left in situ post-surgery for 4–6 weeks, with a mean age of 58 (group one) ± 17.5 (sd) and 62.7 (group two) ± 14.7 (sd) years old. • No stratification for ASA grade/co-morbidities.…”

Section: Resultsmentioning

confidence: 99%

“…The highest-level study enrolled 100 patients [ 27 ]. With this type of prospective RCT a sample size between 425 and 1145 could be used to determine a reduction of infection from 4 to 1% and 4% to 2% assuming 80% power and statistical significance of 5%, although it may be possible that even with a larger sample size the results may not differ significantly.…”

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: Discussionmentioning

confidence: 99%

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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“…One high-quality and one moderate-quality prospective randomized control study have demonstrated that there is no significantly different rate of infection in patients who received perioperative antibiotics compared to those who did not receive antibiotics. 1,3 There are also multiple other low-quality studies to support this finding.…”

Section: Rationalementioning

confidence: 82%

“…A prospective randomized controlled trial of 100 adults undergoing toe fusion with Kirschner wires (K-wires) revealed no significant difference in the infection rate between the group that received prophylactic antibiotics (6.2%) vs the group that did not receive antibiotics (1.9%). 3 Additionally, a recent multicenter, double-blinded, randomized clinical trial of 500 patients undergoing removal of orthopedic implants from the lower extremity in the Netherlands showed no significant difference between the group that received a single preoperative dose of intravenous cefazolin (13.2%) when compared to the group that received saline (14.9%). 1 In their retrospective analysis of 555 patients who underwent elective foot and ankle surgeries, Zgonis et al reported a 1.9% rate of infection in those who received preoperative antibiotics, compared to a 1.4% rate in patients who did not receive preoperative antibiotics.…”

Section: Rationalementioning

confidence: 98%

Are Prophylactic Perioperative Antibiotics Required for Isolated Forefoot Procedures, Such as Hammertoes?

Englund

2019

Foot Ankle Int.

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“…However, antibiotic prophylaxis in human orthopaedic surgery is still recommended if implants remain in the body (15). On the other hand, a recent study of antimicrobial prophylaxis in 100 human patients undergoing lesser toe fusion surgery with K-wire implants did not find a significant difference in development of wound infection between antibiotic-receiving (48/100) and control (52/100) patients (9).…”

Section: Introductionmentioning

confidence: 99%

Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

Stöckle¹,

Failing²,

Koene³

et al. 2018

Tierarztl Prax Ausg G

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Summary Objective: Retrospective analysis of postoperative complications in equines after clean, orthopaedic surgical procedures in order to detect differences between animals treated with antibiotics and horses without receiving these drugs. Material and methods: Details on 652 patients, surgical procedures and surgery-associated complications were compiled from horses being operated between June 2011 and January 2015. Antibiotic-receiving patients (n = 259) were tested for differences in complication rates and characteristics to controls (n = 393). Results: The total complication rate was 39.1 %. Increased swelling was observed most often (25.6 %), followed by exudation (7.5 %), fever without incisional alterations (2.3 %), suture dehiscence (1.8 %), and seroma (0.8 %). Seven patients (five treated, two controls) developed septic arthritis within a total of 463 arthroscopies (1.5 %). There were no significant differences in the development of postoperative complications, which were seen in 97/259 (37.5 %) antibiotic receiving patients and in 158/393 (40.2 %) controls. The application of perioperative antibiotics was significantly influenced by surgeon (p < 0.0001) and type of surgery (p = 0.0007) and increased with the number of surgical lesions (p = 0.03). In patients undergoing tendovaginoscopy/ bursoscopy, fasciotomy and neurectomy (n = 98), antibiotic prophylaxis was initiated less frequently than in other surgeries, e. g. combinations of surgeries, splint bone extraction, tenotomy, and arthroscopy (n = 554). Conclusion: Severe complications in equine clean orthopaedic surgery are rare and complication rates in patients either receiving perioperative antibiotics or not were not significantly different. Clinical relevance: Based on the results the use of antibiotics appears to be non-essential in uncomplicated elective orthopaedic interventions in the horse.

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Role of prophylactic antibiotics in lesser toe fusion surgery: A prospective randomised controlled trial

Cited by 9 publications

References 14 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

Are Prophylactic Perioperative Antibiotics Required for Isolated Forefoot Procedures, Such as Hammertoes?

Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

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