Gans Itai, Jain Amit, Sirisreetreerux Norachart, Haut Elliott R, Hasenboehler Erik A
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline Street, Baltimore, MD 21287 USA.
Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287 USA.
Patient Saf Surg. 2017 Jan 16;11:2. doi: 10.1186/s13037-016-0118-5. eCollection 2017.
The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. However, there is no agreement on the superiority of a single- or multiple-dose perioperative regimen of antibiotic prophylaxis. The purpose of this study is to determine the following: 1) What are the current practice patterns of orthopaedic trauma surgeons in using perioperative antibiotics for closed long bone fractures? 2) What is the current knowledge of published antibiotic prophylaxis guidelines among orthopaedic trauma surgeons? 3) Are orthopaedic surgeons willing to change their current practices?
A questionnaire was distributed via email between September and December 2015 to 955 Orthopaedic Trauma Association members, of whom 297 (31%) responded.
Most surgeons (96%) use cefazolin as first-line infection prophylaxis. Fifty-nine percent used a multiple-dose antibiotic regimen, 39% used a single-dose regimen, and 2% varied this decision according to patient factors. Thirty-six percent said they were unfamiliar with Centers for Disease Control and Prevention (CDC) antibiotic prophylaxis guidelines; only 30% were able to select the correct CDC recommendation from a multiple-choice list. However, 44% of surgeons said they followed CDC recommendations. Fifty-six percent answered that a single-dose antibiotic prophylaxis regimen was not inferior to a multiple-dose regimen. If a level-I study comparing a single preoperative dose versus multiple perioperative antibiotic dosing regimen for treatment of closed long bone fractures were published, most respondents (64%) said they would fully follow these guidelines, and 22% said they would partially change their practice to follow these guidelines.
There is heterogeneity in the use of single- versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single- versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures.
通过合理使用抗生素可降低长骨骨折内固定术后手术部位感染的风险。然而，对于围手术期单剂量或多剂量抗生素预防方案的优越性尚无定论。本研究的目的在于确定以下几点：1）骨科创伤外科医生在闭合性长骨骨折围手术期使用抗生素的当前实践模式是什么？2）骨科创伤外科医生对已发表的抗生素预防指南的当前了解程度如何？3）骨科医生是否愿意改变他们当前的做法？
2015年9月至12月期间，通过电子邮件向955名骨科创伤协会成员发放了问卷，其中297人（31%）回复。
大多数外科医生（96%）使用头孢唑林作为一线感染预防用药。59%的医生采用多剂量抗生素方案，39%采用单剂量方案，2%根据患者因素改变这一决定。36%的医生表示他们不熟悉疾病控制与预防中心（CDC）的抗生素预防指南；只有30%的医生能够从多项选择题列表中选出正确的CDC建议。然而，44%的外科医生表示他们遵循CDC的建议。56%的医生回答单剂量抗生素预防方案并不劣于多剂量方案。如果发表一项比较术前单剂量与围手术期多剂量抗生素给药方案治疗闭合性长骨骨折的I级研究，大多数受访者（64%）表示他们会完全遵循这些指南，22%表示他们会部分改变做法以遵循这些指南。
在闭合性长骨骨折手术修复中，单剂量与多剂量抗生素预防的使用存在异质性。许多外科医生不确定关于围手术期抗生素使用的当前循证推荐。大多数受访者表示他们愿意接受关于单剂量与多剂量围手术期预防性抗生素治疗闭合性长骨骨折的高级别证据。
