Virmani Anurag, Roy Vandana, Meshram Girish Gulab, Sural Sumit
Department of Pharmacology, Maulana Azad Medical College, New Delhi, 110002 India.
Department of Orthopaedics, Maulana Azad Medical College, New Delhi, 110002 India.
Indian J Orthop. 2024 Dec 11;59(2):198-207. doi: 10.1007/s43465-024-01303-3. eCollection 2025 Feb.
To characterize various regimens used for surgical antimicrobial prophylaxis (SAP) in patients undergoing orthopedic implant surgeries (OISs).
A prospective observational study was conducted in patients undergoing OISs to identify various antimicrobial regimens used for SAP. Patients were followed up for a month to detect signs of surgical site infections (SSIs). Risk factors that increase the likelihood of SSIs were determined. Adherence to standard guidelines for SAP was evaluated. Cost analysis and adverse drug reaction (ADR) profiling of each of the regimens used were also done.
Among the 264 patients included, 11 regimens for SAP were followed. Ceftriaxone + amikacin given for 1-5 days was the most common regimen employed (37.87%). One-day regimens (< 24 h) were more commonly prescribed (34.84%) than all other durations (2-5 days). SSIs were observed in 2.37% of the included patients. Gender, presence of cardiovascular comorbidities, low preoperative Hb, and the choice of antimicrobial regimen selected for SAP were associated with SSIs. The adherence rate to standard guidelines for SAP was 35.5%. In our study, ceftriaxone given for < 24 h was the most cost-effective regimen, with the lowest cost per patient (0.28 USD) and no infections. Procurement of ceftriaxone and amikacin contributed to > 70% of the total cost of SAP. Vomiting, epigastric pain, and thrombophlebitis were the common ADRs observed.
SAP practices for patients undergoing OISs are highly variable, with low adherence to standard guidelines. Development of evidence-based national and institution-specific guidelines, along with regular antibiotic stewardship activities, could help curb the heterogeneity in SAP practices.
对接受骨科植入手术（OIS）的患者使用的各种外科抗菌预防（SAP）方案进行特征描述。
对接受OIS的患者进行前瞻性观察研究，以确定用于SAP的各种抗菌方案。对患者进行为期一个月的随访，以检测手术部位感染（SSI）的迹象。确定增加SSI可能性的危险因素。评估对SAP标准指南的依从性。还对所使用的每种方案进行了成本分析和药物不良反应（ADR）分析。
在纳入的264例患者中，遵循了11种SAP方案。头孢曲松+阿米卡星使用1 - 5天是最常用的方案（37.87%）。一日方案（<24小时）的处方频率（34.84%）高于所有其他时长（2 - 5天）。在所纳入的患者中，2.37%观察到SSI。性别、存在心血管合并症、术前血红蛋白水平低以及为SAP选择的抗菌方案与SSI相关。对SAP标准指南的依从率为35.5%。在我们的研究中，<24小时使用头孢曲松是最具成本效益的方案，每位患者成本最低（0.28美元）且无感染发生。头孢曲松和阿米卡星的采购占SAP总成本的70%以上。观察到的常见ADR为呕吐、上腹部疼痛和血栓性静脉炎。
接受OIS患者的SAP实践差异很大，对标准指南的依从性较低。制定基于证据的国家和机构特定指南，以及定期开展抗生素管理活动，有助于遏制SAP实践中的异质性。
