title: Antibiotic prophylaxis in hip surgery: A comparision of two vs. three doses of cefuroxime.
abstract: OBJECTIVE
  To compare the efficacy of two-dose regime with a three-dose regime of cefuroxime in the prevention of post-operative wound infection in hip surgery patients and to determine the most effective regime of antibiotic prophylaxis for such patients.
  
  
  METHODS
  The prospective, comparative, multi-centre cohort study was conducted from January 1998 to June 1998 at Dundee Royal Infirmary and attached district hospitals (Stirling Royal Infirmary and Falkirk Royal Infirmary). It comprised patients who had hip surgery i.e. fracture fixation, hemiarthroplasty or total hip replacement. Patients were assigned to two groups. Group A patients received cefuroxime 750mg at induction of anaesthesia and 750mg at the end of the procedure, while Group B patients received 1.5gm of cefuroxime at the induction of anaesthesia, followed by 750mg 8 and 16 hours after the operation. Patients were assessed post-operatively daily according to the ASEPSIS wound scoring system during the hospital stay.
  
  
  RESULTS
  There were 280 patients in the study, with 140(50%) in each of the two groups. In Group A 60(43%) patients required fracture fixation, the rate of wound infection was 2(3.3%), 40(28.5%) required hemiarthroplasty and the rate of wound infection was 1(2.5%) and 40(28.5%) required total hip replacement and the rate of wound infection was zero. In Group B, the corresponding numbers were 1/60 (1.6%), 1/40 (2.5%) and zero. No evidence of minor, moderate or severe wound infection was observed in 272(97%) patients regardless of the group. The most frequent pathogens were Staphylococcus aureus in 3(1%) patients and Staphylococcus epidermidis in 2(0.7%).
  
  
  CONCLUSIONS
  There was no significant difference in the prevalence of wound infection between the patients who had received two or three doses of cefuroxime.
authors.affiliation: Department of Orthopaedic Surgery, SIMS/Services Hospital, Lahore.
authors.forename: Rana Dilawaiz
authors.initials: RD
authors.lastname: Nadeem
authors.affiliation: Department of Orthopaedic Surgery, KEMU/ Mayo Hospital, Lahore.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Akhtar
authors.affiliation: Department of Orthopaedic Surgery, SIMS/Services Hospital, Lahore.
authors.forename: Omer Iqbal
authors.initials: OI
authors.lastname: Cheema
authors.affiliation: Department of Orthopaedic Surgery, PGMI / General Hospital, Lahore.
authors.forename: Ali Raza
authors.initials: AR
authors.lastname: Hashmi
authors.affiliation: Department of Orthopaedic Surgery, Student, University of California, San Diego, USA.
authors.forename: Mohammed Jazib
authors.initials: MJ
authors.lastname: Nadeem
authors.affiliation: Department of Orthopaedic Surgery, Student, Lahore Medical & Dental College, Pakistan.
authors.forename: Aliza
authors.initials: A
authors.lastname: Nadeem
keywords: Antibiotic prophylaxis, Cefuroxime, ASEPSIS, Hip surgery, THR, Staphylococcus aureus, Staphylococcus epidermidis, UTI, Wound infection.