title: The effectiveness and safety of two prophylactic antibiotic regimes in hip-fracture surgery.
abstract: Antibiotic prophylaxis with cefuroxime can reduce the incidence of deep wound infection (DWI) in hip-fracture surgery, but may increase the risk of C. difficile infection (CDI). An alternative is gentamicin with beta-lactam for which a question exists around clinical effectiveness and safety, given the gentamicin-associated nephrotoxicity particularly in the elderly and narrower sensitivity spectrum. We compared 744 consecutive patients (group I-cefuroxime) with 756 in group II (gentamicin + flucloxacillin) who were well matched. There were 4 cases of CDI in the cefuroxime prophylaxis, whereas none in flucloxacillin plus gentamicin (group II). There was a statistically significant (p = 0.036) increased DWI rate in group II (2.5 %) as compared to group I (1.1 %). However, after controlling for age, gender, ASA grade, surgeon grade, implant type and type of anaesthesia, there was no statistically significant difference between the two groups (p = 0.146). 8.5 % of group I and 16.5 % of group II developed AKI post-operatively (p = 0.023); however, 79 % of group I and 80 % of in group II had complete resolution of AKI prior to their discharge. Further, a significant increase in inpatient deaths (p = 0.057) in group II was observed, but not at 30 days (p = 0.378).
authors.affiliation: Department of Anaesthesia and Critical Care, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK. driftikhar64@doctors.org.uk.
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Hull Royal Infirmary, Hull, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Senior Medical Statistician, Hull and York Medical School, University of Hull, Hull, UK.
authors.forename: V
authors.initials: V
authors.lastname: Allgar
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Hull Royal Infirmary, Hull, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mohsen
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000379:methods; D002444:Cefuroxime / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005436:Floxacillin / Q000008:administration & dosage / Q000009:adverse effects; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D005436:Floxacillin; D002444:Cefuroxime
keywords: Antibiotic prophylaxis; Deep wound infection; Hip fracture; Surgery