Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay.
OBJECTIVE
To compare wound infection, revision rates and hospital stay after major lower limb amputation between patients receiving 24 hours versus 5 days of prophylactic antibiotics.


METHODS
The outcomes of a consecutive series of 40 major lower limb amputations in patients receiving a short 24-hour course of combined prophylactic antibiotics (flucloxacillin/vancomycin + gentamicin/ciproxin + metronidazole) were retrospectively analysed. Following this a further consecutive group of 40 major lower limb amputations were studied prospectively following the institution of a 5-day combined regime using the same antibiotics.


RESULTS
The 2 groups of patients were similar in terms of demographics, vascular risk factors and level of amputation. The 5-day antibiotic regime led to a significant reduction in wound infection rates (5% vs. 22.5%, P=0.023) and a reduced length of hospital stay (22 vs. 34 days, P=0.001). Revision rates were lower (2.5% vs. 10%) but did not reach statistical significance (P=0.36). More patients in the prospective 5-day antibiotic series were operated on by the vascular trainee. (77.5% vs. 55% P=0.033).


CONCLUSIONS
This data supports the use of a prolonged 5-day course of combined antibiotics after major lower limb amputation. This appears to reduce stump infection rates leading to shorter in-hospital stay.
Sadat
U
U
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
Chaudhuri
A
A
Hayes
P D
PD
Gaunt
M E
ME
Boyle
J R
JR
Varty
K
K
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002939:Ciprofloxacin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004739:England / Q000453:epidemiology; D005260:Female; D005436:Floxacillin / Q000008:administration & dosage; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins; D008795:Metronidazole; D005436:Floxacillin; D002939:Ciprofloxacin; D014640:Vancomycin