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Title of Journal: Eur J Orthop Surg Traumatol

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Abbravation: European Journal of Orthopaedic Surgery & Traumatology

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Springer Paris

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DOI

10.1007/978-3-0348-0130-0_46

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ISSN

1432-1068

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The effectiveness and safety of two prophylactic a

Authors: Iftikhar Ahmed M A Khan V Allgar A Mohsen
Publish Date: 2016/05/19
Volume: 26, Issue: 5, Pages: 483-492
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Abstract

Antibiotic prophylaxis with cefuroxime can reduce the incidence of deep wound infection DWI in hipfracture surgery but may increase the risk of C difficile infection CDI An alternative is gentamicin with betalactam for which a question exists around clinical effectiveness and safety given the gentamicinassociated nephrotoxicity particularly in the elderly and narrower sensitivity spectrum We compared 744 consecutive patients group I—cefuroxime with 756 in group II gentamicin + flucloxacillin who were well matched There were 4 cases of CDI in the cefuroxime prophylaxis whereas none in flucloxacillin plus gentamicin group II There was a statistically significant p = 0036 increased DWI rate in group II 25  as compared to group I 11  However after controlling for age gender ASA grade surgeon grade implant type and type of anaesthesia there was no statistically significant difference between the two groups p = 0146 85  of group I and 165  of group II developed AKI postoperatively p = 0023 however 79  of group I and 80  of in group II had complete resolution of AKI prior to their discharge Further a significant increase in inpatient deaths p = 0057 in group II was observed but not at 30 days p = 0378

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