The Role of Prophylactic Antibiotics in Elective Hand Surgery

Cephalosporins in Hand Surgery

“…10 The absolute indications for the administration of prophylactic antibiotics in hand surgery include clean elective procedures greater than 2 hours duration, complex reconstructions, and treatment of dirty wounds such as animal and human bite injuries. 11 Prophylactic antibiotics are not indicated in the treatment of patients with diabetes mellitus, simple lacerations, clean hand injuries, and complex hand trauma (if the anticipated procedure duration is less than 2 hours). 11 Relative indications for use of prophylactic antibiotics include procedures that involve prosthetic implantation or percutaneous K-wire fixation.…”

“…11 Prophylactic antibiotics are not indicated in the treatment of patients with diabetes mellitus, simple lacerations, clean hand injuries, and complex hand trauma (if the anticipated procedure duration is less than 2 hours). 11 Relative indications for use of prophylactic antibiotics include procedures that involve prosthetic implantation or percutaneous K-wire fixation. 11 Patient comorbidities considered relative indications for prophylaxis are rheumatoid arthritis and any nondiabetic immune-compromising disease state.…”

“…11 Patient comorbidities considered relative indications for prophylaxis are rheumatoid arthritis and any nondiabetic immune-compromising disease state. 11 To minimize the risk of a surgical site infection, the selected prophylactic antibiotic should cover the most common infecting pathogens, but need not cover all potential contaminating organisms. 12,13 In patients having an orthopedic procedure, the most common pathogens are gram-positive cocci such as Staphylococcus aureus and Staphylococcus epidermidis, followed by gram-negative bacilli such as Enterobacteriaceae and Pseudomonas aeruginosa.…”

“…14 Based on this spectrum, most authors recommend use of a first-generation cephalosporin, such as cefazolin. 1,2,[11][12][13][15][16][17][18] Cephalosporins are ␤-lactam antibiotics that are closely related, both structurally and functionally, to penicillins. Specific cephalosporins are produced semisynthetically by the chemical attachment of side chains to a 7-aminocephalosporanic acid nucleus.…”

“…Vancomycin and clindamycin are acceptable choices. 1,2,[11][12][13]15,17 Routine use of vancomycin is discouraged because it may promote the emergence of vancomycin-resistant Enterococcus species and Staphylococcus aureus. 18 However, targeted use of vancomycin prophylaxis is appropriate in hospitals with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and in patients with an MRSA infection or colonization.…”