Compliance in Antibiotic Prophylaxis in Orthopaedics and Trauma: Surgical Practice in a Tertiary Hospital, North-West Nigeria

Abstract

Background: Surgical site infection is the surgeons' greatest enemy. The fear of this enemy is even heightened in orthopaedic surgical practice, because of the poor resistance of bone to infections and the consequences when such infection occurs, especially in implant surgeries. Antibiotic prophylaxis is one measure of preventing such “disaster”. For it to be effective, it must be done correctly in accordance with laid down principles. The indiscriminate use of antibiotic prophylaxis, especially the broad spectrum types, has lead to avoidable extra cost of healthcare and the emergence of resistant bacteria strains. Unfortunately, the production of newer antibiotics by the pharmaceutical industries to take care of these new bacteria strains seem not to be keeping pace with their rate of emergence. The only wise option left to curb this problem is therefore the proper use of available antibiotics.
Aim: To audit the compliance of prophylactic Antibiotic practice amongst orthopaedic and trauma surgeons, with popular international guidelines.
Materials and Method: This is a retrospective observational study. The case notes of all patients who had elective surgery for open reduction and internal fixation for closed fractures, primary replacement Arthroplasties, corrective/Realignment osteotomy and surgeries for rigid club foot and received prophylactic antibiotics, between January 2009 to December 2012 were reviewed. Information about the demography, indications for surgery, choice of antibiotics, route, Dose and duration of antibiotics given were collated and analyzed.
Results: On the whole, 253 patients' case notes were retrieved. Of this number, 27 case notes had incomplete or missing documentations and were therefore excluded. A total of 226 case notes were then reviewed. The age range was 0.6 years - 81 years (mean= 40.8years). Males were 188 (83.2% of total). 205(90.7% of total) procedures were guideline compliant for indications for prophylactic antibiotic use. On the choice of antibiotics, only 25(11%) were guideline compliant. On the timing of the first dose , 217(96%) were guideline compliant. While on the administered prophylactic dose and route, all (100%) were compliant. With respect to duration of antibiotic cover, the average duration was 6 days and hence none (0%) was compliant with evidence based guidelines.
Conclusion: The Prophylactic antibiotics practice was shown to be grossly deficient in areas of choice of antibiotics and duration of antibiotic cover. Surgeons should endeavor to practice in accordance with evidence-based local or international guide lines, to reap the expected benefit of prophylactic antibiotics and avoid unwanted adverse effects like emergence of resistant bacteria strains and extra cost of healthcare.

Keywords: Antibiotic Prophylaxis, Orthopaedic -Trauma practice, North-West Nigeria.