Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better.
OBJECTIVE
There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working.


METHODS
In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records.


RESULTS
45% (95% CI: 36-54) of the patients operated in Lund and 57% (CI: 50-64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15-45 min before the start of surgery. 53% (CI: 46-61) received antibiotics 15-45 min before inflation of a tourniquet.


CONCLUSIONS
The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.
Stefánsdóttir
Anna
A
Department of Orthopedics and Clinical Sciences, Lund University Hospital, Lund, Sweden. anna.stefansdottir@med.lu.se
Robertsson
Otto
O
W-Dahl
Annette
A
Kiernan
Sverrir
S
Gustafson
Pelle
P
Lidgren
Lars
L
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002444:Cefuroxime / Q000008:administration & dosage; D002981:Clindamycin / Q000008:administration & dosage; D003023:Cloxacillin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D006801:Humans; D007275:Injections, Intravenous; D017063:Outcome Assessment, Health Care; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D012042:Registries; D013548:Sweden; D013997:Time Factors
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002444:Cefuroxime; D003023:Cloxacillin