E-ISSN 2277-338X | ISSN 2320-4664
 

Original Research 


Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani.

Cited by (1)

Abstract
Background: Prophylactic antimicrobials have an important adjuvant role in the prevention of Surgical Site Infection
(SSI), which is one of the most preventable causes of post-operative complication. In India, due to lack of adequate
information and guidelines for antimicrobial prophylaxis in surgery there is a need to generate baseline data on the
pattern of use of prophylactic antimicrobials.

Aims & Objective: This study is aimed to analyze the pattern of surgical chemoprophylaxis and surgical site infection
(SSI) rate in patients who underwent elective orthopedic surgical procedure.

Material and Methods: A prospective, observational study was performed on patients undergoing surgery, in a
tertiary care teaching hospital. Data were collected in a pro-forma which included the patients’ details, prescriptions
from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by
Centre for Disease Control criteria was recorded.

Results: Total 305 patients were enrolled over a period of one year. In 237 (77.70%) patients antimicrobials
prescribed by generic name. In preoperatively and intraoperatively, all the patients received parenteral antimicrobial.
Postoperatively, 294 (96.40%) patients received only parenteral antimicrobials while in 11 (3.60%) patients received
parenteral antimicrobials followed by oral antimicrobials. Preoperatively antimicrobials started 12 hours prior to
surgery. Average duration of antimicrobials given postoperatively was 5.05 ± 1.14 days. Third generation
Cephalosporins and Aminoglycosides were prescribed most frequently. Average number of antimicrobials used per
patient was 4.40 ± 1.05. In follow up 37 (13.03%) patients developed SSI and most common isolated organism was
Staphylococcus aureus.

Conclusion: Surgical chemoprophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of
administration as well as the total duration of prescription, in majority of the cases, leading to higher SSI. Interventions
are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial
prophylaxis.

Key words: Antimicrobial Prophylaxis; Surgical Site Infection; Orthopedic


 
ARTICLE TOOLS
Abstract
PDF Fulltext
How to cite this articleHow to cite this article
Citation Tools
Related Records
 Articles by Vimesh Mistry
Articles by Ashna Pandya
Articles by Jignesh Chaudhari
Articles by Divyesh Sondarva
Articles by Ajita Pillai
Articles by Shankar Hotchandani
on Google
on Google Scholar


REFERENCES
1. World Health Organization. World Health Organization report on infectious disease. Overcoming antimicrobial resistance. The World Health Report 2000. Geneva: World Health Organization; 2000.
2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999.Infect Control Hosp Epidemiol 1999; 20: 250-78. [DOI via Crossref]    [Pubmed]   
3. Fleming A. Penicillin. Nobel lecture. 1945. Available at http://www.nobelprize. org/medicine/laureates/1945/fleming-lecture.pdf.06 [accessed 01.06.13].
4. Rehospitalizations After Treatment for SSI Add $10 Million to $65 Million to Healthcare Costs. Available at http://www.infectioncontroltoday.com/news/2012/06/rehospitalizations-after-treatment-for-ssi-add-10-to-65-million-to-healthcare-costs.aspx. [Accessed 01.06.13].
5. Perencevich EN, Sands KE, Cosgrove SE. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003; 9:196-203 [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]   
6. Holzeheimer RG, Haupt W, Thiede A, Schwarzkopf A. The challenge of postoperative infections: does the surgeon make a difference? Infect Control Hosp Epidemiol 1997; 18: 449-56.
7. Court-Brown CM. Antibiotic prophylaxis in orthopedic surgery. Scand J Infect Dis 1999; (Suppl 70):74-9.
8. Kato D, Maezawa K, Yonezawa I, Iwase Y, Ikeda H, Nozawa M, Kurosawa H. Randomized prospective study on prophylactic antibiotics in clean orthopedic surgery in one ward for 1 year. J Orthop Sci 2006; 11:20-7. [DOI via Crossref]    [Pubmed]   
9. Giri BR, Pant HP, Shankar PR, Sreeramareddy CT, Sen PK. Surgical site infection and Antibiotics use pattern in a tertiary care hospital in Nepal. J Pak Med Assoc 2008; 58(3): 148-51.
10. Abula T, Kedir M. The pattern of antibiotic usage in surgical in-patients of a teaching hospital, northwest Ethiopia. Ethiop.J.Health Dev. 2004; 18(1): 34-8.
11. Prashanth P, Narendranath S, Geetha M, Naveen Kumar M, Patil N, Reshma SR. Trends in prescribing antimicrobials in post- operative wards in a tertiary care hospital. Drug Invention Today 2011; 3(12): 301-4.
12. Salman MT, Akram MF, Rahman S, Khan FA, Haseen MA, Khan SW. Drug Prescribing Pattern in Surgical Wards of a Teaching Hospital in North India. Indian Journal for the Practicing Doctor 2008; 5(2).
13. Kasteren E, Mannien J, Ott A, Kullberg B, Boer A, Gyssens I. Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor. CID 2007; 44 (1 April): 921-7.
14. Kulkarni RA, Kochhar PH, Dargude VA, Rajadhyakshya SS, Thatte UM. Patterns of antimicrobial use by surgeons in India. Indian J Surg 2005;67:308-15.
15. Khorrami M, Tabatabaei S, Ahmadarabi M. The Efficacy of Short-Term vs. Long-Term Antibiotic Therapy in Preventing Deep Infection After Orthopedic Procedures (A Prospective Observational Study). Jundishapur J Microbiol. 2012; 5(2): 427-9. [DOI via Crossref]   
16. Hassan A, Ibrahim O, Guinaidy M. Surveillance of antibiotic use and resistance in orthopedic department in an Egyptian university hospital. Int J Infect Control 2011; 7(1): 1-10.
17. Kumar S, Behera B, Farooque K, Sharma V, Mathur P. Journal of Association of Physicians of India 2010; 58(1): 124.
18. Yeap JS, Lim JW, Vergis M, Yenng PS, Chin CK, Singh H. Prophylactic Antibiotics in Orthopaedic Surgery: Guidelines and Practice. Med J Malaysia 2006; 61(2): 181-8.
19. Vyas SN, Mirza NY. Use of antibiotics for surgical prophylaxis at tertiary care hospital. IJPI’S Journal of Pharmacology and Toxicology 2011; 1(2): 46-51.
20. Zalavras CG, Patzakis MJ. Open Fractures: Evaluation and Management, JAAOS 2003; 11: 213-5.
21. Cunha BA, Gossling HR, Pasternak HS et al. The penetration characteristics of cefazolin, cephalothin, and cephradine into bone in patients undergoing total hip replacement. J Bone Joint Surg.1977; 59A:856-9.
22. American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999; 56:1839-88.
23. Scottish Intercollegiate Guidelines Network (SIGN) Guidelines 104. Antibiotic prophylaxis in surgery. A national clinical guideline. Edinburgh, UK: SIGN, 2008. Available from http:// www.sign.ac.uk/pdf/sign104.pdf (Accessed 10th September 2012).
24. American Academy of Orthopaedic Surgeons. Information Statement on Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty June 2004. Available at http://www.aaos.org/about/papers/advistmt/1027.asp (Accessed 10th September 2012).
25. Kumar S, Behera B, Farooque K, Sharma V, Mathur P. Journal of Association of Physicians of India 2010; 58(1): 124.
26. Chen YS, Liv YH, Kunin CM, Huang JK, Tsai CC. Use of prophylactic antibiotics in surgery at a Medical centre in southern Taiwan. J Formos Med Assoc 2002; 101:741-8.
27. Bratzler DW, Houck PM, Richards C, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005; 140:174-82. [DOI via Crossref]    [Pubmed]   
28. Dellinger EP, Gross PA, Barrett TL. Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Disease Society of America. Clin Infect Dis 1994; 18: 422-7. [DOI via Crossref]    [Pubmed]   
29. Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000; 101:2916-21. [DOI via Crossref]    [Pubmed]   
30. Pollard JP, Hughes SP, Scott JE, Evans MJ, Benson MK. Antibiotic prophylaxis in total hip replacement. Br Med J 1979; 1:707-9. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]   
31. Heydemann JS, Nelson CL. Short-term preventive antibiotics. Clin Orthop Relat Res 1986; 205:184-7.
32. Strachan CJ. Antibiotic prophylaxis in peripheral vascular and orthopaedic prosthetic surgery. J Antimicrob Chemother. 1993; 31(Suppl B): 65-78.
33. Gaetani G, Carozzi S, Schiesari L, Ferrari PG, Simoncini F. Short term prophylaxis in orthopedic and traumatologic surgery. Chir Ital. 1986; 38(1): 113-8.
34. Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res 2004; 419: 179-84. [DOI via Crossref]    [Pubmed]   
35. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev 2001; (1): CD000244.
36. Malacarne P, Carlotta R, Bertolini G. Antibiotic usage in intensive care units: a phamaco-epidemiological multicenter study. J Antimicrob Chemother 2004; 54(1): 221-4. [DOI via Crossref]    [Pubmed]   
37. Khan SA, Rao PG. Surgical antibiotic prophylaxis in an Indian hospital. Journal of Pharmacy Practice and Research 2006; 36(2): 163.
38. Yohannes Y, Mengesha Y, Tewelde Y. Timing, choice and duration of perioperative prophylactic antibiotic use in surgery: A teaching hospital based experience from Eritrea. Journal of Eritrean Medical Association 2009; 4(1): 65-7.
39. Goswami NN, Trivedi H, Goswami AP, Patel TK, Tripathi CB. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India. J Pharmacol Pharmacother 2011; 2(3): 158-64. [DOI via Crossref]    [Pubmed]    [PMC Free Fulltext]   
40. Wassef M, Hussein A, Rahman A, El-Sherif R. A prospective surveillance of surgical site infections: Study for efficacy of preoperative antibiotic prophylaxis. African Journal of Microbiology Research 2012; 6(12): 3072-8. [DOI via Crossref]   
41. Purghel F, Badea R, Ciuvica R, Anastasiu A. The use of antibiotics in traumatology and orthopaedic surgery. MAEDICA A Journal of Clinical Medicine 2006; 1(3): 58-65.
42. Prokuski L. Prophylactic Antibiotics in Orthopaedic Surgery. J Am Acad Orthop Surg 2008; 16:283-93.
43. Kalmeijer MD, van Nieuwland-Bollen E, Bogaers-Hofman D, deBaere G, Kluytmans JAJW. Nasal Carriage of Staphlococcus aureus as a Major Risk Factor for Surgical Site Infections in Orthopedic Surgery. Inf Control Hosp Epidemiol 2000;21:319-323. [DOI via Crossref]    [Pubmed]   
44. Meehan J, Jamali A, Nguyen H. Prophylactic Antibiotics in Hip and Knee arthroplasty. J Bone Joint Surg Am. 2009; 91: 2480-90. [DOI via Crossref]    [Pubmed]   

This Article Cited By the following articles

Assessment of surgical antimicrobial prophylaxis in Orthopaedics and Traumatology Surgical Unit of a Tertiary Care Teaching Hospital in Addis Ababa
BMC Res Notes 2017; 10(1): .

1
 
How to Cite this Article
Pubmed Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. Int J Med Sci Public Health. 2013; 2(4): 994-1000. doi:10.5455/ijmsph.2013.020820131


Web Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. https://www.ijmsph.com/?mno=39664 [Access: April 05, 2022]. doi:10.5455/ijmsph.2013.020820131


AMA (American Medical Association) Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. Int J Med Sci Public Health. 2013; 2(4): 994-1000. doi:10.5455/ijmsph.2013.020820131



Vancouver/ICMJE Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. Int J Med Sci Public Health. (2013), [cited April 05, 2022]; 2(4): 994-1000. doi:10.5455/ijmsph.2013.020820131



Harvard Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani (2013) Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. Int J Med Sci Public Health, 2 (4), 994-1000. doi:10.5455/ijmsph.2013.020820131



Turabian Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. 2013. Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. International Journal of Medical Science and Public Health, 2 (4), 994-1000. doi:10.5455/ijmsph.2013.020820131



Chicago Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. "Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms." International Journal of Medical Science and Public Health 2 (2013), 994-1000. doi:10.5455/ijmsph.2013.020820131



MLA (The Modern Language Association) Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani. "Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms." International Journal of Medical Science and Public Health 2.4 (2013), 994-1000. Print. doi:10.5455/ijmsph.2013.020820131



APA (American Psychological Association) Style

Vimesh Mistry, Ashna Pandya, Jignesh Chaudhari, Divyesh Sondarva, Ajita Pillai, Shankar Hotchandani (2013) Use of antimicrobial prophylaxis in clean elective orthopedic surgical procedures and identifying common infective organisms. International Journal of Medical Science and Public Health, 2 (4), 994-1000. doi:10.5455/ijmsph.2013.020820131





Most Viewed Articles
  • Internet addiction among professional courses students: A study from central India
    Arvind Sharma, Rupesh Sahu, Pradeep Kumar Kasar, Richa Sharma
    Int J Med Sci Public Health. 2014; 3(9): 1069-1073
    » Abstract & References » doi: 10.5455/ijmsph.2014.180620142

  • Management of Appendicular Lump: Early exploration Vs conservative management
    Chandra Prakash Pandey, Ram Chandra Kesharwani, Chandra Gopal Singh Chauhan, Manmohan Krishna Pandey, Purnima Mittra, Pramod Kumar, Arshad Raza
    Int J Med Sci Public Health. 2013; 2(4): 1046-1049
    » Abstract & References » doi: 10.5455/ijmsph.2013.230820131

  • Burden of non communicable diseases in India: Setting priority for action
    Kalpa Sharma
    Int J Med Sci Public Health. 2013; 2(1): 7-11
    » Abstract & References » doi: 10.5455/ijmsph.2013.2.7-11

  • Diabetic nephropathy: Progression and pathophysiology
    Deepak N Parchwani, Amit A Upadhyah
    Int J Med Sci Public Health. 2012; 1(2): 59-70
    » Abstract & References » doi: 10.5455/ijmsph.2012.1.59-70

  • Elevated levels of serum uric acid, creatinine or urea in preeclamptic women
    Magna Manjareeka, Sitikantha Nanda
    Int J Med Sci Public Health. 2013; 2(1): 43-47
    » Abstract & References » doi: 10.5455/ijmsph.2013.2.43-47

  • Most Downloaded
  • Minor disorder of pregnancy and its home management
    Lata Gururani, Atul Kumar, Gomathi Mahalingam
    Int J Med Sci Public Health. 2016; 5(4): 684-687
    » Abstract & References » doi: 10.5455/ijmsph.2016.03082015111

  • Association between serum ferritin and thyroid hormone profile in hypothyroidism
    Ashuma Sachdeva, Veena Singh, Isha Malik, Prasanta Saha Roy, Himanshu Madaan, Rajesh Nair
    Int J Med Sci Public Health. 2015; 4(6): 863-865
    » Abstract & References » doi: 10.5455/ijmsph.2015.24012015174

  • Internet addiction among professional courses students: A study from central India
    Arvind Sharma, Rupesh Sahu, Pradeep Kumar Kasar, Richa Sharma
    Int J Med Sci Public Health. 2014; 3(9): 1069-1073
    » Abstract & References » doi: 10.5455/ijmsph.2014.180620142

  • Effect of sleep deprivation on the attitude and performance of medical students, Riyadh, Saudi Arabia
    Hussein Saad Amin, Ibrahim Salamah Almazroua, Abdullah Sulaiman Alsahlan, Mohammed Abdullah Alrishan, Houssam Mourad Elmourad, Mohammed Mansour Alotaibi, Abdulaziz Ibrahim Almohaisin
    Int J Med Sci Public Health. 2016; 5(3): 575-580
    » Abstract & References » doi: 10.5455/ijmsph.2016.17112015207

  • Management of Appendicular Lump: Early exploration Vs conservative management
    Chandra Prakash Pandey, Ram Chandra Kesharwani, Chandra Gopal Singh Chauhan, Manmohan Krishna Pandey, Purnima Mittra, Pramod Kumar, Arshad Raza
    Int J Med Sci Public Health. 2013; 2(4): 1046-1049
    » Abstract & References » doi: 10.5455/ijmsph.2013.230820131

  • Most Cited Articles
  • Zinc: The trace element of major importance in human nutrition and health
    Jayant D Deshpande, Mohini M Joshi, Purushottam A Giri
    Int J Med Sci Public Health. 2013; 2(1): 1-6
    » Abstract & References » doi: 10.5455/ijmsph.2013.2.1-6
    Cited : 61 times [Click to see citing articles]

  • Internet addiction among professional courses students: A study from central India
    Arvind Sharma, Rupesh Sahu, Pradeep Kumar Kasar, Richa Sharma
    Int J Med Sci Public Health. 2014; 3(9): 1069-1073
    » Abstract & References » doi: 10.5455/ijmsph.2014.180620142
    Cited : 26 times [Click to see citing articles]

  • A study on the prevalence of refractive errors among school childern of 7-15 years age group in the field practice areas of a medical college in bangalore
    Pavithra MB, Maheshwaran R, Rani Sujatha MA
    Int J Med Sci Public Health. 2013; 2(3): 641-645
    » Abstract & References » doi: 10.5455/ijmsph.2013.220420131
    Cited : 23 times [Click to see citing articles]

  • Examination stress and its effect on EEG
    Sunil Kumar Jena
    Int J Med Sci Public Health. 2015; 4(11): 1493-1497
    » Abstract & References » doi: 10.5455/ijmsph.2015.23042015308
    Cited : 23 times [Click to see citing articles]

  • Burden of non communicable diseases in India: Setting priority for action
    Kalpa Sharma
    Int J Med Sci Public Health. 2013; 2(1): 7-11
    » Abstract & References » doi: 10.5455/ijmsph.2013.2.7-11
    Cited : 21 times [Click to see citing articles]