Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor.
BACKGROUND
Surgical site infections (SSIs) following total hip arthroplasty can lead to prolonged hospitalization, increased morbidity and mortality, and high costs. This article analyzes the effect of various parameters of surgical antibiotic prophylaxis on the risk of SSI following total hip arthroplasty.


METHODS
Data about SSI and potential prophylaxis-, patient-, and procedure-related risk factors were prospectively collected for 1922 patients who underwent elective total hip arthroplasty in 11 hospitals that participated in the Dutch intervention project, Surgical Prophylaxis and Surveillance. Multivariate logistic regression analysis was performed to correct for random variation among hospitals.


RESULTS
SSIs (superficial and deep) occurred in 50 patients (2.6%). The highest odds ratios for SSI were found in patients who received prophylaxis after incision (2.8, 95% confidence interval [CI], 0.9-8.6; P=.07), had an American Society of Anesthesiology score that was >2 (2.8, 95% CI, 0.8-9.2; P=.09), and experienced a duration of surgery that was >75th percentile (2.5; 95% CI, 1.1-5.8; P=.04). Prolonged prophylaxis after the end of surgery and the use of antibiotic-impregnated cement did not contribute to fewer SSIs in this study.


CONCLUSIONS
This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis.
van Kasteren
Marjo E E
ME
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. M.v.Kasteren@elisabeth.nl
Manniën
Judith
J
Ott
Alewijn
A
Kullberg
Bart-Jan
BJ
de Boer
Annette S
AS
Gyssens
Inge C
IC
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents