title: Perioperative infection rate in patients with osteosarcomas treated with resection and prosthetic reconstruction.
abstract: BACKGROUND
  The incidence of perioperative infection after segmental tumor endoprosthetic replacement in previous reports varies from a high of 7.4% to a low of 2.6%. Appropriate antibiotic use for this group is unknown and controversial, whereas the relationship of antibiotic use and perioperative infection is unclear.
  
  
  OBJECTIVE
  We determined the incidence of perioperative infection in patients with osteosarcoma treated with segmental prosthetic replacement using a standard perioperative antibiotic regimen and the incidence of late infections and wound complications.
  
  
  METHODS
  We retrospectively reviewed the records of 53 patients with osteosarcoma undergoing segmental prosthetic replacements from 1993 to 2008. There were 30 males and 23 females ranging from 10 to 78 years of age. All patients were given intraoperative antibiotics (intravenous cefazolin), continued for 3 days postoperatively and then given orally for 5 days. Patients who were allergic to penicillin or cefazolin were given vancomycin followed by clindamycin. A perioperative infection was defined as a deep infection within 2 months after prosthetic reconstruction. The minimum followup was 1 year (range, 1-15 years).
  
  
  RESULTS
  We identified one confirmed perioperative prosthetic infection (1/53; 1.9%) (Enterobacter cloacae and methicillin-resistant Staphylococcus) in a 78-year-old woman after proximal tibial replacement, gastrocnemius flap, and skin graft. Her infection was controlled with débridement, drainage, and intravenous antibiotics. Three patients had late infections, two of which were culture negative. Four patients had wound complications that required further surgery.
  
  
  CONCLUSIONS
  The antibiotic regimen we used is longer than that recommended for patients having routine total joint arthroplasty. Its appropriateness will require comparison with alternate regimens, including those of shorter duration.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Moretti
authors.forename: Adedayo O
authors.initials: AO
authors.lastname: Ashana
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lackman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000295:instrumentation*; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D003646:Debridement; D004322:Drainage; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015994:Incidence; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery*; D015143:Philadelphia; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents