Antibiotic prophylaxis; anti-adhesion membrane use in pediatric patients; postoperative oxygen; supplemental oxygen.(EVIDENCE FOR PRACTICE)

Effective antibiotic prophylaxis in arthroplastic surgery The Journal of Bone and Joint Surgery September 2005

Infection after total hip arthroplasty is a serious complication that may result in removal of the prosthesis. Such infections can occur through hematogenous seeding but more commonly, they occur from bacteria entering the wound at the time of the surgical procedure. Antibiotic prophylaxis has been identified as an effective method to address this problem when the antibiotics are administered in a time frame that would establish therapeutic levels in the bloodstream before the incision is made. For antibiotic prophylaxis to be effective, however, the antibiotics must be active against the pathogens most likely to contaminate the surgical wound. Most postoperative prosthetic hip infections are caused by gram-positive bacteria, predominately staphylococci. Beta-lactam-resistant staphylococci have become increasingly common, resulting in decreased effectiveness of antibiotic prophylaxis using pencillins or cephalosporins, including cefuroxime. The purpose of this study was to identify the contaminating bacteria after hip arthroplasty and to establish the bacteria's sensitivity to prophylactic antibiotics in current use. (1)

During the course of 50 total hip arthroplasty procedures performed at a university hospital in England, the gloved hands of the surgeon, first assistant, and scrub nurse were cultured. Immediately after gloves were either changed or discarded, impressions of the staff member's right and left hands were obtained on the same blood agar plate. Gloves were changed after draping and at 20-minute intervals, immediately before using cement, and whenever a visible puncture was detected. All isolates were identified by gram stain and were tested for sensitivity to floxacillin, a recognized indicator of sensitivity to cefuroxime. Gram-positive isolates also were tested against gentamicin, fusidic acid, and linezolid. Escherichia coli (E coli) isolates were tested against gentamicin, cefuroxime, and amoxicillin, and Pseudomonas species were tested against gentamicin, ceftazidime, piperacillin, and tazobactum. Common statistical procedures were used to analyze the data.

Findings. Six hundred twenty-seven pairs of gloved hands were cultured. Fifty-seven (ie, 9%) were found to be contaminated. Of the 106 isolates recovered, coagulase-negative staphylococcus accounted for 69.9%, micrococcus accounted for 12.3%, diphtheriods accounted for 9.3%, Staphylococcus aureus accounted for 6.6%,…