title: Antibiotic Prophylaxis Regimens in Trauma and Orthopaedic Surgery: Are We Providing Adequate Cover Against Colonizing Organisms?
abstract: Trauma, elective orthopaedics, and an aging population will result in an increasing health burden and work load. The move to surgical podiatrists in the National Health Service within the United Kingdom will shift the surgical workload away from orthopaedic surgeons. A devastating complication of foot and ankle surgery is postoperative infection. While postoperative infection is multifactorial in etiology, concomitant diabetes mellitus increases the general risk of trauma and orthopaedic surgical site infections up to 8-fold. We therefore undertook a prospective study of our unit antibiotic prophylaxis regimes. Fifty patients participated. Swabs were obtained using aseptic technique from the plantar aspect of the feet, between the toes, and subsequently cultured on agar plates. Specimens were then incubated for 48 hours before being exposed to antibiotic plates. Cultured organisms were classified as susceptible to an antibiotic regimen if susceptibility to cefuroxime, or susceptibility to either drug of the flucloxacillin/gentamicin combination, was demonstrated. Statistical analysis e was performed. A P value <.05 was considered significant. Fifty patients were recruited, 26 (52%) were male. Mean age of 53 ± 19.4 years. The cohort included 15 diabetic, of which 11 (73.3%) insulin-dependent, and 35 nondiabetic patients. Comparing flucloxacillin/gentamicin against cefuroxime overall, susceptibility was noted in 84% and 70%, respectively (P = .096). Resistance to cefuroxime was significantly higher in diabetics than in nondiabetics (53% vs 25%, P = .046). The same pattern was observed for the flucloxacillin/gentamicin regimen (33% vs 9%, P = .049). While both regimens are active against colonizing organisms in this prospective observational study, flucloxacillin and gentamicin provide greater coverage overall. We have demonstrated that the use of flucloxacillin/gentamicin provides better coverage against commensal bacterial flora compared with cefuroxime alone. This is of even greater importance in the case of the specific high-risk subgroups, such as diabetic patients.
  
  
  METHODS
  Level IV: Case Series.
authors.affiliation: Royal Victoria Hospital, Belfast, UK atuc@hotmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Tucker
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: L
authors.initials: L
authors.lastname: Henderson
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: R
authors.initials: R
authors.lastname: Moffatt
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: R
authors.initials: R
authors.lastname: Abela
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: J
authors.initials: J
authors.lastname: Troughton
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: R
authors.initials: R
authors.lastname: McMullan
authors.affiliation: Royal Victoria Hospital, Belfast, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wilson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D054869:Clinical Audit; D002985:Clinical Protocols; D003920:Diabetes Mellitus / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005436:Floxacillin / Q000627:therapeutic use; D005528:Foot / Q000382:microbiology; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010865:Pilot Projects; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005436:Floxacillin
keywords: general disorders; infections; trauma