Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients |
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Authors: | Kristopher M. Lundine Susan Nelson Richard Buckley Sven Putnis Paul J. Duffy |
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Affiliation: | * Division of Orthopaedics, Health Sciences Centre, Calgary, Alta., the;† School of Medicine, Queen’s University, Kingston, Ont., and the;‡ Trauma & Orthopaedic Registrar, St. Georges Hospital, London, United Kingdom |
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Abstract: | BackgroundThe goal of this study was to assess whether patients receive their antibiotic prophylaxis as prescribed. We also investigated what doses and durations of antibiotics are typically ordered, which patients actually receive antibiotics and factors causing the ordered antibiotic regimen to be altered.MethodsWe performed a retrospective review of 205 patient charts and sent a national survey to all surgeon members of the Canadian Orthopaedic Trauma Society (COTS) about antibiotic prophylaxis in the setting of surgical treatment for closed fractures.ResultsIn all, 93% (179 of 193) of patients received an appropriate preoperative dose of antibiotics, whereas less than 32% (58 of 181) of patients received their postoperative antibiotics as ordered. The most commonly stated reason for patients not receiving their postoperative antibiotics as ordered was patients being discharged before completing 3 postoperative doses. There was a 70% (39 of 56) response rate to the survey sent to COTS surgeons. A single dose of a first-generation cephalosporin preoperatively followed by 3 doses postoperatively is the most common practice among orthopedic trauma surgeons across Canada, but several surgeons give only preoperative prophylaxis.ConclusionAdherence to multidose postoperative antibiotic regimens is poor. Meta-analyses have failed to demonstrate the superiority of multidose regimens over single-dose prophylaxis. Single-dose preoperative antibiotic prophylaxis may be a reasonable choice for most orthopedic trauma patients with closed fractures. |
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