Among patients who underwent clean orthopedic procedures, discontinuation of antibiotic prophylaxis (ABP) within 24 hours of wound closure was non-inferior to discontinuation within 48 hours for prevention of hospital-acquired infections (HAIs) , according to the results of a study conducted in Open JAMA Network.
This open-label, cluster-randomised trial was conducted at multiple centers in Japan between May 2018 and December 2018. Eligible patients included those who were 20 years of age and older, and proper orthopedic procedures were determined via Centers’ wound classification for Disease Control and Prevention. system. The primary endpoint was the incidence of postoperative IASS requiring antibiotic therapy over a 30-day period.
A total of 1211 patients were included in the analysis, of whom 633 stopped ABP within 24 hours (group A) and 578 stopped ABP within 24 to 48 hours (group B). Among patients in groups A and B, the median age was 73 (IQR, 61-80) and 74 (IQR, 62-81) years, and 60.5% and 64.7% were female, respectively.
A total of 29 (4.6%) HAIs (4.6%) occurred in patients in group B versus 38 (6.6%) in those in group B, indicating a significantly decreased risk of HAI in those in whom ABP was discontinued within 24 hours (risk difference [RD], -1.99; 95% CI, -5.05 to 1.06; P
Similar results were observed in the intention-to-treat adjusted population, which excluded patients who deviated from the protocol indicated by their assigned group. Results were also similar after excluding patients who received topical antibiotics and those in whom iodine-impregnated adhesive drapes and antimicrobial-coated sutures for the prevention of surgical site infections (SSI) were not used.
The occurrence of SSI, urinary tract infections and respiratory tract infections decreased in group A patients compared to group B (RD, -1.08; 95% CI, -2.98 to 0.83). No significant difference between the groups was observed in the crude estimate of postoperative hospitalizations for IASS within 30 days (relative risk [HR], 1.17; 95% CI, 0.86-1.60). Further analysis showed that the risk of antimicrobial resistant pathogens in patients in group A (n=2) compared to group B (n=4) who developed IASS was not significantly different (DR , -0.38; 95% CI, -1.31 to 0.59).
Limitations included the inability to assign completely blinded groups, potential selection bias, and limited generalizability due to differences in patient care between Japan and other countries.
“Our results support the global goal against antimicrobial resistance, which can reduce the socio-economic burden, especially in institutions where [ABP] duration is always implemented,” the researchers concluded.
Disclosure: Some authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original reference for a full list of disclosures.
Nagata K, Yamada K, Shinozaki T, et al. Effect of duration of antimicrobial prophylaxis on nosocomial infections after clean orthopedic surgery: a cluster randomized trial. JAMA Netw Open. 2022;5(4):e226095. doi: 10.1001/jamanetworkopen.2022.6095