整形外科周術期におけるリスクマネージメント周術期における予防的抗菌薬投与の現状

抄録

Pre and postoperative antibiotic therapies in surgery are associated with reduce incidences of wound infection. However, because of side effects, long term prescription of the antibiotics should be avoided. In order to clarify effectiveness of antimicrobial prophylaxis (AMP) in orthopaedic surgery, we surveyed it institution.
One hundred seventy two patients, 89 males and 83 females, with a mean age of 51 years, who underwent surgery between November 2005 and June 2006 at our institution were investigated. Operations consisted of total knee and hip joint arthroplasty (34 patients), spinal decompression (47 patients) and arthroscopic surgery including ligament reconstruction of knee, meniscus injury, synovectomy, and shoulder surgery (91 patients). Antibiotic type, administration period, method of AMP, and surgical site infection (SSI) incidence were investigated. Cefazolin was the most commonly administrated antibiotic (98.2%). Mean administration period of AMP was 2.6, 1.3 and 1.4 days for joint arthroplasty, spinal decompression, and arthroscopic surgery, respectively. In 31 of 45 patients surgical procedure was longer than 3 hours. There patients received an additional dosage of antibiotic. Twenty one patients (29%) did not receive any antibiotic in the postoperative period. The incidence of SSI was 1.2% (2/172). Infections were superficial. Overall the administration period of AMP was short in our institution. In cases of joint arthroplasty the administration period was shorter than proposed in the guidelines. In case of spinal decompression and arthroscopic surgery one day administration on the operative day was considered sufficient for AMP. Further studies are required to determine the optimal AMP method in the near future.