在择期足踝手术中，我们需要常规术后预防性口服抗生素吗？
Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?
作者信息
Lachance Andrew D, Giro Margaret E, Edelstein Alexander, Klos Eliza, Lee Wonyong
机构信息
Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA.
出版信息
Foot Ankle Orthop. 2024 Jan 28;9(1):24730114231224796. doi: 10.1177/24730114231224796. eCollection 2024 Jan.
BACKGROUND
Previous studies about antibiotic prophylaxis in foot and ankle surgery have focused on perioperative intravenous administration, with few studies reporting on the efficiency of postoperative oral antibiotics. The purpose of this study is to investigate differences in the rate of postoperative infection and wound complications between patients with and without postoperative oral antibiotics and to identify independent risk factors for these complications following foot and ankle surgeries.
METHODS
A retrospective review of all elective foot and ankle surgeries with at least a 6-month follow-up was performed over a 2-year time span. Patients were divided into 2 groups based on if they received postoperative oral antibiotics. We compared the rates of postoperative infections and wound complications between the 2 groups. The surgical site, the number of codes, and the number of surgical incisions were also noted. Multivariable logistic regression analysis was performed to identify independent risk factors of postoperative infection and wound complications.
RESULTS
A total of 366 patients were included in this study-240 with antibiotics and 126 without antibiotics. There was no significant difference in the rates of postoperative infection and wound complications between the 2 groups. The rate of superficial infection, deep infection, and wound complications was 1.7%, 0.8%, and 5.8% in the antibiotic group vs 3.2%, 0.0%, and 4.0% in patients without antibiotics, respectively. Multivariable logistic regression analysis identified independent risk factors of postoperative infection and wound complications as follows: smoking (OR: 4.7), male (OR: 4.0), history of neoplasm (OR: 6.7), and multiple incisions (OR: 4.1).
CONCLUSION
Our results suggest that routine postoperative prophylactic oral antibiotics are not needed following elective foot and ankle surgeries. However, certain risk factors may increase the risk for postoperative infection and wound complications in foot and ankle surgery.
LEVEL OF EVIDENCE
Level III, case-control study.
背景
既往关于足踝手术抗生素预防的研究主要集中在围手术期静脉给药，很少有研究报道术后口服抗生素的效果。本研究的目的是调查术后口服抗生素与未口服抗生素患者术后感染率和伤口并发症的差异，并确定足踝手术后这些并发症的独立危险因素。
方法
对所有进行了至少6个月随访的择期足踝手术进行了为期2年的回顾性研究。根据患者是否接受术后口服抗生素将其分为两组。我们比较了两组之间的术后感染率和伤口并发症发生率。还记录了手术部位、编码数量和手术切口数量。进行多变量逻辑回归分析以确定术后感染和伤口并发症的独立危险因素。
结果
本研究共纳入366例患者，其中240例使用抗生素，126例未使用抗生素。两组之间的术后感染率和伤口并发症发生率无显著差异。抗生素组的浅表感染率、深部感染率和伤口并发症发生率分别为1.7%、0.8%和5.8%，未使用抗生素的患者分别为3.2%、0.0%和4.0%。多变量逻辑回归分析确定术后感染和伤口并发症的独立危险因素如下：吸烟（比值比：4.7）、男性（比值比：4.0）、肿瘤病史（比值比：6.7）和多处切口（比值比：4.1）。
结论
我们的结果表明，择期足踝手术后无需常规预防性口服抗生素。然而，某些危险因素可能会增加足踝手术术后感染和伤口并发症的风险。
证据水平
III级，病例对照研究。
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