title: Implementation of a short course of prophylactic antibiotic treatment for prevention of postoperative infections in clean orthopaedic surgeries.
abstract: OBJECTIVE
  Perioperative antimicrobial prophylaxis constitutes the bulk of antimicrobial consumption in any hospital. This study was conducted at a level 1 Trauma Centre of a tertiary care hospital of India to assess the efficacy of a short (24 h) course of perioperative antibiotic prophylactic regimen in preventing surgical site infections (SSI) in open reduction and internal fixation (ORIF) of closed fractures of limbs and to assess if the same can be implemented as a general policy.
  
  
  METHODS
  Patients of either sex, aged 18 yr or more, who were scheduled for ORIF and were willing and able to give informed consent, were included in the study. Patients were randomly allocated into two groups. Group 1 (n=100) received 3 doses of 1 g i.v. cefuroxime perioperatively spaced 12 h apart and group 2 (n=97) received the conventional existing regimen [5 days of i.v. antibiotics (cefuroxime 1 g twice daily along with amikacin 15 mg/kg in 2 divided doses), followed by oral cefuroxime, 500 mg twice daily till suture removal].
  
  
  RESULTS
  Of the 197 patients, four patients developed a surgical site infection (three with methicillin resistant Staphylococcus aureus and one Acinetobacter baumanii). Of these, two patients were in group 1 and the remaining two in group 2. These patients were treated with i.v. antibiotics based on the culture and antimicrobial sensitivity reports. The cost of the short course treatment was ` 150 per patient as compared to ` 1,900 per patient for conventional regimen.
  
  
  CONCLUSIONS
  There was no significant difference in rates of SSI among the two groups in our study. Cost evaluation revealed that shorter course was less expensive than conventional long course regimen. Implementation of a short course perioperative regimen will go a long way in reducing antimicrobial resistance, cost and adverse reactions to antimicrobials.
authors.affiliation: Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. purvamathur@yahoo.co.in
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
authors.forename: Vivek
authors.initials: V
authors.lastname: Trikha
authors.forename: Kamran
authors.initials: K
authors.lastname: Farooque
authors.forename: Vijay
authors.initials: V
authors.lastname: Sharma
authors.forename: Neetu
authors.initials: N
authors.lastname: Jain
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhardwaj
authors.forename: Satyapriya
authors.initials: S
authors.lastname: Sharma
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D005260:Female; D005596:Fractures, Closed / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007194:India; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D011184:Postoperative Period; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents