Prophylactic antibiotics in podiatric foot and ankle surgery

NewsBot · Feb 8, 2017

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The use of prophylactic antibiotics in podiatric foot and ankle surgery
Paul Butterworth, Alexander Terrill, Alex Barwick, Robert Hermann
Infection, Disease & Health; 8 February 2017

Highlights
•The use of prophylactic antibiotic therapy has not been evaluated in the Australian podiatry community.
•Surgeon experience may influence infection rates in podiatric foot and ankle surgical practice.
•Perioperative antibiotics may reduce the risk of infection, however the use or addition of postoperative antibiotics does not.
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Objective
Infection is a common and serious complication following surgery. Whether antibiotic prophylaxis reduces infection rates in podiatric foot and ankle surgery is unclear. The aim of this prospective cohort study therefore, was to determine the impact of antibiotic use on infection rates following podiatric foot and ankle surgery.

Methods
Data from 4238 patients who underwent foot and ankle surgery between January 2014 and January 2016 were analysed. Infections within the first 30 days following surgery were recorded according to the Australasian College of Podiatric Surgeons national audit descriptors. Logistic regression analyses were undertaken to determine whether antibiotic prophylaxis decreased the rate of surgical site infection.

Results
Of the 4238 patient records, 4140 records (98%) provided complete data (aged 2–92 years, mean 48.9 ± SD 19.6, 1124 males, and 3016 females). A total of 79 infections (1.9% infection rate) were reported. More experienced surgeons documented a lower rate of infection (OR 0.36, 95% CI 0.17–0.72, P < 0.01) and the use of perioperative antibiotics was associated with lower infection rates than those that received no antibiotics (OR 0.42, 95% CI 0.22–0.81, P = 0.01). There was no significant association found between age, sex, and ASA score with infection. The use of postoperative antibiotics alone and in addition to perioperative antibiotics was not associated with reduced surgical site infection rates.

Conclusion
Surgeon experience may influence infection rates in podiatric foot and ankle surgical practice, and the use of perioperative antibiotics may reduce the risk of infection. The use or addition of postoperative antibiotics does not reduce infection rates, and should be used by podiatric surgeons with caution.
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Admin2 · Feb 8, 2017

Related Topics:
Clinical Consensus Statement: Perioperative Prophylactic Antibiotic Use in Clean Elective Foot Surgery
Prophylactic Antibiotics

NewsBot · Dec 28, 2017

Effect of Antibiotic Prophylaxis on Surgical Site Infections Following Removal of Orthopedic Implants Used for Treatment of Foot, Ankle, and Lower Leg Fractures: A Randomized Clinical Trial.
Backes M et al
JAMA. 2017 Dec 26;318(24):2438-2445. doi: 10.1001/jama.2017.19343.

IMPORTANCE:
Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee.

OBJECTIVE:
To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee.

DESIGN, SETTING, AND PARTICIPANTS:
Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, allergy for cephalosporins, known kidney disease, immunosuppressant use, or pregnancy.

INTERVENTIONS:
A single preoperative intravenous dose of 1000 mg of cefazolin (cefazolin group, n = 228) or sodium chloride (0.9%; saline group, n = 242).

MAIN OUTCOMES AND MEASURES:
Primary outcome was SSI within 30 days as measured by the criteria from the US Centers for Disease Control and Prevention. Secondary outcome measures were functional outcome, health-related quality of life, and patient satisfaction.

RESULTS:
Among 477 randomized patients (mean age, 44 years [SD, 15]; women, 274 [57%]; median time from orthopedic implant placement, 11 months [interquartile range, 7-16]), 470 patients completed the study. Sixty-six patients developed an SSI (14.0%): 30 patients (13.2%) in the cefazolin group vs 36 in the saline group (14.9%) (absolute risk difference, -1.7 [95% CI, -8.0 to 4.6], P = .60).

CONCLUSIONS AND RELEVANCE:
Among patients undergoing surgery for removal of orthopedic implants used for treatment of fractures below the knee, a single preoperative dose of intravenous cefazolin compared with saline did not reduce the risk of surgical site infection within 30 days following implant removal.
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NewsBot · Nov 16, 2018

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature
Mr Ravi Krishān Modha et al
Journal of Foot and Ankle Research201811:61

Background
With the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.

Methodology
A systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.

Results
Overall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.

Conclusion
Whilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.
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NewsBot · Jun 8, 2022

Comparing Local Perioperative Methods and Antibiotic Prophylaxis
in Surgical Site Infection Prevention
Sravani Sai Alla, B.S., Jessica Trujillo Landeros-Arnold, B.S., Anushka Sunil Ramnani, B.S.
Extremitis

Objectives: Surgical site infection prevention is a key component of medicine that can be used to prevent morbidity
and mortality. This literature review aims to compare local modalities with a baseline modality of antibiotic
prophylaxis in terms of efficacy and benefit to the patient.
Methods: A PubMed search was conducted on relevant clinically- based research articles from the years 1986-2019.
Each method was analyzed in its respective setting.
Results: Perioperative oxygenation and antimicrobial irrigation have shown to have promising results in lowering the
rates of SSIs while triclosan-loaded sutures, which also lower the rates of SSIs (OR 0.72, 95% CI 0.59-0.88), may be
better suited for higher risk surgical procedures. Perioperative antibiotics yield little to no difference in preventing
SSIs.32 1.6% of patients who received antibiotics acquired a postoperative infection versus 1.4% who did not receive
antibiotics acquired a postoperative infection .
32
Conclusion: In conclusion, the literature indicates that there are various methods that can aid in preventing surgical
site infections including local perioperative measures site infections including local perioperative measures as well as
antibiotic prophylaxis. While antibiotic prophylaxis is not recommended routinely in clean, uncomplicated surgeries,
it may be recommended to use local modalities in concert with antibiotic prophylaxis. However, further research is
necessitated.
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NewsBot · Jul 2, 2022

Efficacy of Postoperative Oral Antibiotics in Foot and Ankle Surgery
Robert M Frederick et al
Foot Ankle Int. 2022 Jul 1

Background: Preoperative oral antibiotic use in patients undergoing foot and ankle surgery is standard practice, but no consensus has been reached regarding the efficacy of postoperative oral antibiotics. The purpose of this study was to determine whether postoperative oral antibiotics reduce the rate of surgical site infections (SSIs) in patients, with and without comorbidities, undergoing foot and ankle surgery.

Methods: A retrospective chart review was conducted identifying patients who underwent foot and ankle surgery by 4 fellowship-trained, foot and ankle orthopaedic surgeons between January 1, 2015, and January 1, 2019. Patients were divided into 2 groups: those who received postoperative oral antibiotics (group 1) and those who did not (group 2). Two surgeons routinely prescribed postoperative oral antibiotics, and 2 did not. Demographics, comorbidities, and procedure complexity based on surgical site and Current Procedural Terminology code were recorded from the charts. The primary outcome was postoperative infection (superficial or deep) within 6 months after surgery. Patients with antibiotic use prior to surgery, preoperative infection, or lack of follow-up >6 weeks were excluded. Multivariate logistic regression modeling was used to analyze differences in infection rate and severity.

Results: Chart review identified 3631 patients, 1227 of whom did not receive postoperative oral antibiotics whereas 2394 patients did. Routine postoperative oral antibiotic use did not significantly affect postoperative infection rates or severity. However, all covariates studied (diabetes, hypertension, obesity, tobacco use, alcohol use, rheumatoid conditions, and age) influenced postoperative infection rates and severity.

Conclusion: The results of this study indicate that postoperative oral antibiotics are not associated with differences in infection rates or severity. We do not recommend routine use in foot and ankle surgery.
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NewsBot · Mar 9, 2023

Postoperative Infection and Revision Surgery Rates in Foot and Ankle Surgery Without Routine Prescription of Prophylactic Antibiotics
Neal Huang, Daniel T Miles, Connor R Read, Charles C White, Richard D Murray, Andrew W Wilson, Jesse F Doty
J Am Acad Orthop Surg Glob Res Rev. 2023 Mar 8;7(3)

Introduction: Surgical site infections (SSIs) are associated with patient morbidity and increased healthcare costs. Limited literature in foot and ankle surgery provides guidance about routine administration of postoperative antibiotic prophylaxis. The purpose of this study was to examine the incidence and revision surgery rates of SSI in outpatient foot and ankle surgeries in patients not receiving oral postoperative antibiotic prophylaxis.

Methods: A retrospective review of all outpatient surgeries (n = 1517) conducted by a single surgeon in a tertiary referral academic center was conducted through electronic medical records. Incidence of SSI, revision surgery rate, and associated risk factors were determined. The median follow-up was 6 months.

Results: Postoperative infection occurred in 2.9% (n = 44) of the surgeries conducted, with 0.9% of patients (n = 14) requiring return to the operating room. Thirty patients (2.0%) were diagnosed with simple superficial infections, which resolved with local wound care and oral antibiotics. Diabetes (adjusted odds ratio, 2.09; 95% confidence interval, 1.00 to 4.38; P = 0.049) and increasing age (adjusted odds ratio, 1.02; 95% confidence interval, 1.00 to 1.04; P = 0.016) were significantly associated with postoperative infection.

Discussion: This study demonstrated low postoperative infection and revision surgery rates without the routine prescription of prophylactic postoperative antibiotics. Increasing age and diabetes are signficant risk factors for developing a postoperative infection.
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