title: Incidence and Risk Factors for Infection When Teicoplanin Is Included for Prophylaxis in Patients with Hip Fracture.
abstract: BACKGROUND
  Surgical site infection (SSI) rate after surgery for hip fracture is about 4%. The aim of the present study was to review the efficacy of dual prophylaxis using teicoplanin plus cefuroxime and risk factors for SSI.
  
  
  METHODS
  Operations for hip fracture from 2012 to 2013 were retrospectively reviewed. Relevant information was gathered: Demographics, comorbidities, ASA score, laterality, type of fracture, type of surgery, d from admission to surgery, length of surgery, hemoglobin value at admission, urinary or respiratory infections, and the need for pre-operative, intra-operative, and post-operative red blood cell (RBC) transfusion. Prophylaxis consisted of cefuroxime and teicoplanin during the induction of anesthesia. U.S. Centers for Disease Control and Prevention (CDC) criteria for superficial and deep SSI were applied. Univariate and multivariable analysis were performed.
  
  
  RESULTS
  Six hundred fifty-seven patients were included in the study. Thirteen (2.0%) SSI were identified, six superficial (0.9%), and seven deep (1.1%). Staphylococcus aureus was isolated in two infections (one superficial and one deep). The SSI rate was 2.4% in intra-medullary nails (n = 334), 1.4% in prostheses (n = 211), and 1.8% in other synthesis (n = 112). Parameters independently associated with SSI were: Intra-operative RBC transfusion (OR: 11.6, p = 0.002), length of surgery >120 min (OR: 4.5, p = 0.02), and having a urinary infection (OR: 4.28, p = 0.02).
  
  
  CONCLUSIONS
  Dual prophylaxis including cefuroxime and teicoplanin was associated with a 2% rate of SSI. Staphylococcus aureus caused only two SSIs. Reducing SSI is of utmost importance for patients' quality of life and to avoid additional cost of surgical procedures. Therefore, more experience with dual prophylaxis is needed to confirm our results.
authors.affiliation: 1 Department of Internal Medicine, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Aina
authors.initials: A
authors.lastname: Capdevila
authors.affiliation: 1 Department of Internal Medicine, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Margarita
authors.initials: M
authors.lastname: Navarro
authors.affiliation: 2 Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Guillem
authors.initials: G
authors.lastname: Bori
authors.affiliation: 2 Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Eduard
authors.initials: E
authors.lastname: Tornero
authors.affiliation: 2 Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Pilar
authors.initials: P
authors.lastname: Camacho
authors.affiliation: 3 Department of Microbiology, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Jordi
authors.initials: J
authors.lastname: Bosch
authors.affiliation: 1 Department of Internal Medicine, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Sebastián
authors.initials: S
authors.lastname: García
authors.affiliation: 4 Department of Infectious Diseases, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: 4 Department of Infectious Diseases, Hospital Clínic, University of Barcelona , Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .
authors.forename: Alex
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001858:Bone Nails / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D002444:Cefuroxime / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D062785:Hemiarthroplasty / Q000009:adverse effects; D006620:Hip Fractures / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D061646:Operative Time; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000517:prevention & control*; D017334:Teicoplanin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D002444:Cefuroxime