![]() We also hypothesized that many orthopaedic trauma surgeons would be unfamiliar with published antibiotic prophylaxis guidelines but would be willing to change their practices to help prevent SSI. We hypothesized that there would be heterogeneity in practice patterns among orthopaedic trauma surgeons in terms of using single- versus multiple-dose antibiotic regimens. Recent reviews have highlighted the controversy that exists in the literature in selection of an antibiotic dosing regimen for prevention of surgical site infection although there is widespread use, there is no agreed-upon agent or dosing duration that has been found to be statistically superior. The choice of single- versus multiple-dose perioperative antibiotics is influenced by factors such as injury severity, comorbidities, and duration of surgery. In fact, the American Academy of Orthopaedic Surgeons Committee on Patient Safety published guidelines in 2009 recommending perioperative antibiotic treatment to include a single preoperative dose and intraoperative re-dosing based on procedure length and blood loss and to discontinue antibiotics within 24 h after wound closure however, the recommendations do not specify whether a single preoperative antibiotic dose or a 24-h prophylaxis regimen is recommended. Appropriate dosing is necessary to ensure the agent’s concentration exceeds the minimal bactericidal concentration against the target pathogen at the surgical site for the duration of surgery. These guidelines, however, do not indicate whether postoperative continuation of antibiotic prophylaxis is necessary. The Centers for Disease Control and Prevention (CDC) Infection Control and Hospital Epidemiology guidelines published in 1999 recommend that antibiotics be re-administered if the duration of surgery is expected to exceed the time during which therapeutic levels of the antibiotic can be maintained and, at most, until a few hours after the surgery has ended. Although antibiotic administration before incision is the standard of care, there is no agreement on the appropriate perioperative duration of antibiotic prophylaxis. Īntibiotic administration before surgical incision has markedly improved the safety of modern surgery, especially in cases with high risk of infection, including the use of retained prosthetic instrumentation as is used in closed long bone fracture repair. ![]() Perioperative antibiotic prophylaxis can help prevent SSI, and studies have shown the benefit of administering antibiotics immediately before skin incision in closed fracture surgery. Rates of SSI after surgery for closed fractures range from 1 to 4%. Surgical site infections (SSIs) account for approximately 38% of all postoperative infections and can be devastating after treatment of long bone fractures.
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