title: Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection.
abstract: BACKGROUND
  Widespread overuse and inappropriate use of antibiotics contribute to increasingly antibiotic-resistant pathogens and higher health care costs. It is not clear whether routine antibiotic prophylaxis can reduce the rate of surgical site infection (SSI) in low-risk patients undergoing orthopaedic surgery. We designed a simple scorecard to grade SSI risk factors and determined whether routine antibiotic prophylaxis affects SSI occurrence during open reduction and internal fixation (ORIF) orthopaedic surgeries in trauma patients at low risk of developing SSI.
  
  
  METHODS
  The SSI risk scorecard (possible total points ranged from 5 to 25) was designed to take into account a patient's general health status, the primary cause of fractures, surgical site tissue condition or wound class, types of devices implanted, and surgical duration. Patients with a low SSI risk score (≤8 points) who were undergoing clean ORIF surgery were divided into control (routine antibiotic treatment, cefuroxime) and evaluation (no antibiotic treatment) groups and followed up for 13-17 months after surgery.
  
  
  RESULTS
  The infection rate was much higher in patients with high SSI risk scores (≥9 points) than in patients with low risk scores assigned to the control group (10.7% vs. 2.2%, P<0.0001). SSI occurred in 11 of 499 patients in the control group and in 13 of 534 patients in the evaluation group during the follow-up period of 13-17 months. The SSI occurrence rate did not differ significantly (2.2% vs. 2.4%, P=0.97) between the control and evaluation groups.
  
  
  CONCLUSIONS
  Routine antibiotic prophylaxis does not significantly decrease the rate of SSI in ORIF surgical patients with a low risk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics.
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Jiangshan, Jiangshan City, Zhejiang 324100, PR China. Electronic address: xxsgy@sina.com.
authors.forename: Sheng-Gen
authors.initials: SG
authors.lastname: Xu
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Jiangshan, Jiangshan City, Zhejiang 324100, PR China.
authors.forename: Zhao-Guang
authors.initials: ZG
authors.lastname: Mao
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Jiangshan, Jiangshan City, Zhejiang 324100, PR China.
authors.forename: Bin-Sheng
authors.initials: BS
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, The People's Hospital of Jiangshan, Jiangshan City, Zhejiang 324100, PR China.
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Zhu
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: huilinpan@mdanderson.org.
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Pan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002444:Cefuroxime / Q000008:administration & dosage*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime
keywords: Ceftriaxone; Cefuroxime; Infection risk factors; Orthopaedic surgeries; Prophylactic antibiotics; Trauma