Strict peri-operative antibiotic prophylaxis in surgical fixation of fractures: Experience from a trauma centre in Nigeria

Abstract

Background: Infection remains one of the most dreaded complications of internal fixation as infection alters the natural history and outcome of  fracture care. Therefore, antimicrobial prophylaxis for orthopaedic surgeries has become the standard of care in closed fracture surgery as it has been shown to reduce the incidence of SSIs especially when antibiotics is combined with other aseptic protocols during surgeries. However, in most developing countries, this guideline is often not strictly adhered.
Aim: This study aimed at reviewing the experience from strict implementation of short course peri-operative antibiotic protocol for fracture fixation in a trauma centre in Nigeria.
Method: Prospectively collected data of subsets of patients that presented with closed fractures treated by surgical fixation from 1st January 2008 to 31st December 2012 after commencement of the implementation of the peri-operative antibiotic policy in the regional trauma centre in Port Harcourt Nigeria was analysed and presented.
Result: One thousand one hundred and fifty-four cases (75.4%) involved males while 377 (24.6%) of the cases affected females giving a male to  female ratio of 3.1:1. A significant proportion of the fractures were treated by intramedullary nailing 664 (43.4%) followed by fixation using plate and screws 422 (27.6%). Seventy-eight (5.1%) of the fractures were treated by external fixation, Six hundred and ninety-three (45.3%) of the patients were hospitalised for less than one week and 1171 of the patients (76.5%) of the patients had been discharged from admission as at two weeks following admission. A significant proportion of the fractures had shown evidence of radiological union as at 12 weeks post surgery 1030 (67.3%).
The main complications observed following treatment of the fractures were infections 65 (4.2%), Malunion 44 (2.9%), Non-union 34 (2.2%). The  organisms cultured as causative agents of the infections was Staphylococcus aureus 22 (33.8%), Pseudomonas 11 (16.9%), Escherichia coli 7 (10.8%). Others were mixed organisms 25 (38.5%).
Conclusion: Peri-operative antibiotic prophylaxis is the standard of care for fracture fixation surgeries particularly in those requiring an implant.  Whereas antibiotic prophylaxis helps to reduce postoperative infections, it should be an adjunct and should not replace essential aseptic protocols
and precautions required for clean surgeries.

Keywords: Prophylaxis, Antibiotics, Surgical site infections, Closed fractures.