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Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture

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Abstract

Purpose

The aim of this study was to conduct a re-evaluation of current strategies for peri-operative prophylaxis of infections in orthopaedic surgery of geriatric patients (≥65 years) with proximal femoral fractures (PFF).

Methods

Between 01/2010 and 08/2014 all post-operative infections after stabilization of PFF of 1,089 geriatric patients were recorded retrospectively. All patients pre-operatively received a single dose of 1.5 g cefuroxime (group 1). These were compared to prospectively determined post-operative rates of surgical site infection (SSI) of 441 geriatric patients, which were operated on between 09/2014 and 03/2017 due to PFF. In this second group we investigated the urinary tract on admission. Bacteriuria was treated with the pre-operative single dose of 1.5 g cefuroxime along with ciprofloxacin for five days, beginning on admission. Level of significance was set to p < 0.05.

Results

A total of 141 patients of group 2 had a bacteriuria. Seventy-seven of these patients revealed biochemical signs of manifest urinary tract infection. Multi-resistant pathogens were found in 15 patients and pathogens were cefuroxime-resistant in 37. The differences of SSI after at least three months were 2.1% in group 1 and 0.45% in group 2 for all patients with surgery of PFF (p < 0.02) and for those with arthroplasty (p < 0.037) significant.

Conclusions

The immediate antibiotic therapy of a prevalent bacteriuria for five days decreases the risk of SSI after surgery of PFF. Our single-centre study can only point out the problem of prevalent reservoirs of pathogens and the need for treatment. Evidence-based therapy concepts (indications of antibiotics, classes, duration) have to be developed in multi-centric and prospective studies.

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Funding

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, centre, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Virchowstrasse 10, 78224, Singen, Germany

    Ronny Langenhan, Stefanie Bushuven & Axel Probst

  2. Department of Orthopaedic Surgery, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116, Chemnitz, Germany

    Niklas Reimers

Authors
  1. Ronny Langenhan
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  2. Stefanie Bushuven
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  3. Niklas Reimers
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  4. Axel Probst
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Corresponding author

Correspondence to Ronny Langenhan.

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Conflict of interest

The authors declare no competing interests.

This study was approved by the local ethics committee (Landesärztekammer BW, F-2016-068).

Additional information

Investigation performed at the Department of Orthopaedic Surgery, Hegau-Bodensee-Klinikum Singen, Germany

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Langenhan, R., Bushuven, S., Reimers, N. et al. Peri-operative antibiotic treatment of bacteriuria reduces early deep surgical site infections in geriatric patients with proximal femur fracture. International Orthopaedics (SICOT) 42, 741–746 (2018). https://doi.org/10.1007/s00264-017-3708-7

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  • DOI: https://doi.org/10.1007/s00264-017-3708-7

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