[Antibiotic prophylaxis of postoperative infection in orthopedics. Results of an epidemiologic survey in Italy conducted by the Journal of Chemotherapy].

An epidemiological survey of the use of antimicrobial prophylaxis in Italian hospitals was carried out under the auspices of the Journal of Chemotherapy. Out of 500 Italian orthopedic centers requested, 225 have participated in this study. A total of 136,321 surgical procedures were reported in the 166 centers reporting complete answers on type of surgery. They comprised hip and knee prosthesis (13.9\%), spine surgery (4\%), hip endoprosthesis (5.2\%), osteosynthesis (26.9\%), arthroscopy (24.4\%), and others (25.5\%). Perioperative antimicrobial prophylaxis was used in 75\% of operations (ranging from 57.1\% to 99.4\% in arthroscopy and joint prosthesis, respectively). Short term (< 24 h) antimicrobial prophylaxis was performed in 38.4\% of the 206 Centers answering this question correctly. 61.1\% of Centers employed single agent prophylaxis. 70.8\% of these prescriptions were betalactam antibiotics. Bacteriological analysis of the wound in 86 Centers (total number of isolates 2013) revealed the presence of Gram-positive isolates in 73.7\% of cases. Methicillin resistance was expressed in 45\% of 915 tested strains. Out of 4221 patients with high risk of infectious complications (joint prosthesis surgery) given antimicrobial prophylaxis in 46 Centers, the percentage of surgical wound infections was overall 2.1\%, while that of non-surgical wound infections was 3.6\%. A decrease in the total infection rate by about half was associated with long-term (> 24 h) as compared to short-term (< 24 h) antibiotic treatment (3.7 vs 7.6\%, respectively), and with the use of antibiotic drug combinations vs single antibiotic drugs (3.9 vs 6.6\%, respectively). The incidence of surgical-site infection is not decreased by extending the chemoprophylaxis for more than the first 24 h after surgery, while it is reduced from 2.5 to 1.4\% by use of combination antibiotic therapy.