Antimicrobial rationing in orthopaedic surgery

[摘要] The use of prophylactic systemic antibiotics in the perioperative period has beenshown to reduce postoperative infections following arthroplasty procedures,1,2tumour surgery,3 and trauma procedures.4In open fractures, the administration ofsystemic broad-spectrum antibiotics hasbeen shown to be a more important factor inminimizing the risk of infection than timingof surgical debridement.5,6 Local antibioticprophylaxis using bone cement has beenshown to reduce the risk of deep postoperative infection following arthroplasty surgerysignificantly.7-9 More recently a systematicreview and meta-analysis found that localantibiotic prophylaxis resulted in a four-foldrelative risk reduction in fracture-relatedinfection following open limb injury.10 TheWorld Health Organization (WHO) recommends preoperative screening and eradication in orthopaedic surgery of not onlymethicillin-resistant Staphylococcus aureus(MRSA) but methicillin-sensitive S. aureus(MSSA).11 Evaluation of these strategieshas shown them to be both effective12-15and acceptable to patients.16 An economicanalysis estimated that national S. aureusscreening programmes could potentiallysave up to $900 million in total treatmentcosts annually in the USA and UK.

[学科分类] 骨科学

[关键词] Antimicrobials;Antimicrobial resistance;Antimicrobial rationing