Can Prophylactic Antibiotics Help Reduce The Risk Of Infection During Surgery?

By Brian McCurdy, Senior Editor

Podiatric surgery can carry inherent risks including the possibility of perioperative infection. A recent article in the Journal of Bone and Joint Surgery (JBJS) offers several pertinent recommendations that aim to prevent some of the reported 780,000 surgical site infections that occur every year in the United States, according to the study authors.

Although they acknowledge that preoperative antibiotics are associated with lower rates of surgical site infections, the authors of the JBJS article say surgeons should continue antibiotics for no more than 24 hours after elective surgery of surgical treatment of closed fractures. The article also contends chlorhexidine gluconate is superior to povidone-iodine when it comes to preoperative antisepsis.

However, in regard to prophylactic antibiotics, Gary Jolly, DPM, notes “the evidence does not show that their use in elective foot and ankle surgery reduces the risk of infection despite a fairly strong trend to use prophylactic antibiotics.”

He cites his own retrospective study in the Journal of Foot and Ankle Surgery on the topic of prophylactic antibiotics. Dr. Jolly, the Chief of Podiatric Surgery at New Britain General Hospital in New Britain, Ct., also notes he is currently involved in a prospective, randomized, controlled, blinded study on this subject. With 200 patients enrolled thus far in the study, Dr. Jolly says he has seen no difference in infection rates between those taking prophylactic antibiotics and those not taking them.

Surgeons usually use a povidone-iodine base in the hospitals in which Dr. Jolly operates but he says they will use other products if faced with patients with allergies. However, he does not think this is a major issue.
Jesse Burks, DPM, has used both chlorhexidine gluconate and/or povidone-iodine. He says he has not noted any variation in perioperative infection rates anecdotally.

Pertinent Pearls For Reducing The Risk Of Infection
The JBJS authors also say the rate of postoperative infections associated with occlusive dressings is lower than that of non-occlusive dressings. Appropriately managing blood glucose levels, oxygenation and the patient’s temperature reduces the risk of postoperative infection, according to the study authors. One should consider medications and disease processes that may compromise the patient’s immune system, according to Dr. Burks, a Fellow of the American College of Foot and Ankle Surgeons.

Although Dr. Burks feels prevention of infection is “impossible,” he does offer some pearls to reduce the incidence of perioperative infection. He argues that surgeons should take responsibility for aseptic techniques throughout the entire operating room and not just for their specific technique. Dr. Burks, who practices in Little Rock, Ark., adds that surgeons should consider the infection history of the OR in which they are operating.

Dr. Jolly also advocates strict observation of sterile techniques and atraumatic tissue handling. Neal Blitz, DPM, will pre-wash the extremity with isopropyl alcohol to remove any major debris before a formal surgical prep. Dr. Blitz performs the pre-wash himself and will not delegate the task to a resident or nurse.

“It always amazing to see how much dirt and grime comes off,” notes Dr. Blitz, an attending podiatric surgeon in the Department of Orthopedics and Foot and Ankle Surgery at the Kaiser Permanente Medical Center in Santa Rosa, Calif.

Dr. Jolly also recommends limiting the time that a surgical wound is open.

“Surgeons who are slow and careless technically are more likely to see wound infections as well as other types of wound complications,” notes Dr. Jolly, a Fellow and Past President of the American College of Foot And Ankle Surgeons.

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