Surgical Antimicrobial Prophylaxis in Orthopedic Implant Surgeries: An Analysis of Practices, Outcomes, and Costs.

IF 1.1 4区医学 Q3 ORTHOPEDICS

Indian Journal of Orthopaedics Pub Date : 2024-12-11 eCollection Date: 2025-02-01 DOI:10.1007/s43465-024-01303-3

Anurag Virmani, Vandana Roy, Girish Gulab Meshram, Sumit Sural

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引用次数: 0

Abstract

Purpose: To characterize various regimens used for surgical antimicrobial prophylaxis (SAP) in patients undergoing orthopedic implant surgeries (OISs).

Method: A prospective observational study was conducted in patients undergoing OISs to identify various antimicrobial regimens used for SAP. Patients were followed up for a month to detect signs of surgical site infections (SSIs). Risk factors that increase the likelihood of SSIs were determined. Adherence to standard guidelines for SAP was evaluated. Cost analysis and adverse drug reaction (ADR) profiling of each of the regimens used were also done.

Results: Among the 264 patients included, 11 regimens for SAP were followed. Ceftriaxone + amikacin given for 1-5 days was the most common regimen employed (37.87%). One-day regimens (< 24 h) were more commonly prescribed (34.84%) than all other durations (2-5 days). SSIs were observed in 2.37% of the included patients. Gender, presence of cardiovascular comorbidities, low preoperative Hb, and the choice of antimicrobial regimen selected for SAP were associated with SSIs. The adherence rate to standard guidelines for SAP was 35.5%. In our study, ceftriaxone given for < 24 h was the most cost-effective regimen, with the lowest cost per patient (0.28 USD) and no infections. Procurement of ceftriaxone and amikacin contributed to > 70% of the total cost of SAP. Vomiting, epigastric pain, and thrombophlebitis were the common ADRs observed.

Conclusion: SAP practices for patients undergoing OISs are highly variable, with low adherence to standard guidelines. Development of evidence-based national and institution-specific guidelines, along with regular antibiotic stewardship activities, could help curb the heterogeneity in SAP practices.

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骨科植入手术中的外科抗菌预防：实践、结果和成本分析。

目的：描述骨科植入手术（OISs）患者外科抗菌预防（SAP）的各种方案。方法：一项前瞻性观察研究在接受ois的患者中进行，以确定用于SAP的各种抗菌方案。患者随访一个月，以检测手术部位感染（ssi）的迹象。确定了增加ssi发生可能性的危险因素。对SAP标准指导方针的依从性进行了评估。还对所使用的每种方案进行了成本分析和药物不良反应（ADR）分析。结果：纳入的264例患者中，有11个SAP方案得到了随访。头孢曲松+阿米卡星1 ~ 5 d是最常见的治疗方案（37.87%）。1天方案（占SAP总费用的70%）。呕吐、胃脘痛和血栓性静脉炎是观察到的常见不良反应。结论：ois患者的SAP实践变化很大，对标准指南的依从性较低。制定以证据为基础的国家和机构特定指南，以及定期开展抗生素管理活动，可以帮助遏制SAP实践中的异质性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Orthopaedics ORTHOPEDICS-

CiteScore

1.80

自引率

0.00%

发文量

185

审稿时长

9 months

期刊介绍： IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.