title: Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients.
abstract: BACKGROUND
  The goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. We also investigated what doses and durations of antibiotics are typically ordered, which patients actually receive antibiotics and factors causing the ordered antibiotic regimen to be altered.
  
  
  METHODS
  We performed a retrospective review of 205 patient charts and sent a national survey to all surgeon members of the Canadian Orthopaedic Trauma Society (COTS) about antibiotic prophylaxis in the setting of surgical treatment for closed fractures.
  
  
  RESULTS
  In all, 93% (179 of 193) of patients received an appropriate preoperative dose of antibiotics, whereas less than 32% (58 of 181) of patients received their postoperative antibiotics as ordered. The most commonly stated reason for patients not receiving their postoperative antibiotics as ordered was patients being discharged before completing 3 postoperative doses. There was a 70% (39 of 56) response rate to the survey sent to COTS surgeons. A single dose of a first-generation cephalosporin preoperatively followed by 3 doses postoperatively is the most common practice among orthopedic trauma surgeons across Canada, but several surgeons give only preoperative prophylaxis.
  
  
  CONCLUSIONS
  Adherence to multidose postoperative antibiotic regimens is poor. Meta-analyses have failed to demonstrate the superiority of multidose regimens over single-dose prophylaxis. Single-dose preoperative antibiotic prophylaxis may be a reasonable choice for most orthopedic trauma patients with closed fractures.
authors.affiliation: Division of Orthopaedics, Health Sciences Centre, 3330 Hospital Dr. NW, Calgary, Alberta. krislundine@hotmail.com
authors.forename: Kristopher M
authors.initials: KM
authors.lastname: Lundine
authors.forename: Susan
authors.initials: S
authors.lastname: Nelson
authors.forename: Richard
authors.initials: R
authors.lastname: Buckley
authors.forename: Sven
authors.initials: S
authors.lastname: Putnis
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Duffy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002170:Canada; D002506:Cephalexin / Q000627:therapeutic use; D005260:Female; D005596:Fractures, Closed / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D019990:Perioperative Care / Q000592:standards*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002506:Cephalexin