[Evidence-based antibiotic prophylaxis in aseptic orthopedic surgery].
Disagreement exists on the topic of antibiotic prophylaxis in aseptic orthopedic surgery. No evidence on the usefulness of prophylactic antibiotic administration exists with regard to non-complex aseptic surgeries without placement of osteosynthetic material. Likewise, no undisputed evidence exists on the usefulness of antibiotic prophylaxis with regard to aseptic orthopedic surgeries involving placement of osteosynthetic material. However, the majority of experts agree on antibiotic prophylaxis in the latter cases. In contrast clear evidence does exist regarding the usefulness of antibiotic prophylaxis with first- or second-generation cephalosporins for surgeries of the hip involving fracture treatment or prosthetic replacement. The prophylactic use of glycopeptides should be confined to cases of high MRSA or MRSE risk. Administration of prophylactic antibiotics should precede incision time by around 30 min and tourniquet inflation by at least 10 min. Antibiotic administration may be repeated in the OR when surgery lasts longer than 3 h. The use of local antibiotics in bone cement has not proven useful as a prophylactic measure.
Hunfeld
K-P
KP
Institut für Medizinische Mikrobiologie, Klinikum, Johann-Wolfgang-Goethe-Universität, Frankfurt/M. K.Hunfeld@em.uni-frankfurt.de
Wichelhaus
T A
TA
Schäfer
V
V
Rittmeister
M
M
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip; D016022:Case-Control Studies; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D018849:Controlled Clinical Trials as Topic; D004311:Double-Blind Method; D019317:Evidence-Based Medicine; D005265:Femoral Neck Fractures / Q000601:surgery; D005593:Fracture Fixation, Internal; D006020:Glycopeptides; D006801:Humans; D015201:Meta-Analysis as Topic; D009985:Orthopedics; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D014111:Tourniquets
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D006020:Glycopeptides; D010919:Placebos