title: Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better.
abstract: 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.
authors.affiliation: Department of Orthopedics and Clinical Sciences, Lund University Hospital, Lund, Sweden. anna.stefansdottir@med.lu.se
authors.forename: Anna
authors.initials: A
authors.lastname: Stefánsdóttir
authors.forename: Otto
authors.initials: O
authors.lastname: Robertsson
authors.forename: Annette
authors.initials: A
authors.lastname: W-Dahl
authors.forename: Sverrir
authors.initials: S
authors.lastname: Kiernan
authors.forename: Pelle
authors.initials: P
authors.lastname: Gustafson
authors.forename: Lars
authors.initials: L
authors.lastname: Lidgren
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D002444:Cefuroxime; D003023:Cloxacillin