The Study On The Effect Of Antibiotic Prophylaxis Of Closed Fracture Internal Fixation In The Perioperative Period

Objective Closed fracture internal fixation is one of the commonly used orthopedic procedures to treat fractures.However,surgical site infection seriously affects the prognosis of patients.International guidelines all recommend antibiotic prophylaxis for SSI with fracture internal fixation,but some recent studies have shown that there is no significant effect in the SSI rate between patients with and without antibiotic prophylaxis.Therefore,there is still no agreement on whether prophylactic antibiotics could reduce SSI rate of closed fracture internal fixation in the perioperative period.The aim of this study was to analyze the relationship between perioperative antibiotic prophylaxis and postoperative SSI,and to determine whether prophylactic antibiotics has application value.Meanwhile,we further evaluated the effect of antibiotic prophylaxis in fracture patients with single risk factors.Methods 1.The patients with closed fractures internal fixation of limbs who met the criteria from January 2015 to December 2020 in Orthopaedics Department of a tertiary hospital were selected as the study object.Carefully view the disease history records of the study object,select the clinical data of patients,and set the prevention and non-prevention groups;2.The baseline data of patients in two groups were compared.After 1:1 Propensity-Score Matched,the baseline characteristics of the patients were well balanced between the two groups.The SSI in the two groups was continuously observed after surgery,and the related clinical symptoms,postoperative white blood cell count,postoperative neutrophil percentage and the mean temperature were recorded as infection indexes.Then the difference of SSI rate between the two groups was analyzed;3.Further survey the SSI in two groups with risk factors to determine whether patients need antibiotic prophylaxis,subgroup analysis was conducted.The results involved a comparison of antibiotic prophylaxis in the following patient groups:advanced age,obesity,diabetes mellitus,hypertension,smoking status,alcohol consumption,preoperative stay≥7 days,operative duration≥180 minutes,intraoperative blood loss≥400 ml,total hospital stay≥15 days and patients with anomalous preoperative laboratory examinations(white blood cell>10.00×10~9/L,neutrophil percentage>75%,lymphocyte>3.20×10~9/L,hemoglobin<110 or 120 g/L and albumin<35 g/L);4.SPSS 22.0(SPSS,Chicago,Illinois,USA)related software was used for all statistical analysis.Descriptive statistics for the baseline characteristics of the patients were performed between the prevention and non-prevention groups.The binary Logistic regression was used to determine the association between primary antibiotic prophylaxis and postoperative infection,adjusting for potential confounders to balance the baseline data.Categorical variables are presented as counts and percentages.χ~2tests were used for categorical variables.A two-sided P value<0.05 was considered statistically significant.Result 1.Most of the patients had lower limbs fractures(56.9%).The second-generation cephalosporins were the main drugs in the prevention group(83.8%);2.Before matching,901cases of closed limbs fracture internal fixation were included,comprising 616 cases in the prevention group and 285 cases in the non-prevention group.The results of baseline data(demography,clinical and surgical features)showed that there were significant differences in age,body mass index,diabetes,hypertension,smoking,alcohol,preoperative stay,operation duration,intraoperative blood loss,total hospital stay,preoperative hemoglobin and preoperative albumin between the two groups(P<0.05).It had 518 cases in the last two groups after matching,259 cases in each two group,and the baseline data of the two groups were all balanced(P>0.05).3.There were 15 cases of SSI in the two groups.9 patients(3.5%)developed SSI in the prevention group,which included 7(2.7%)superficial and 2(0.8%)deep infections.Compared to 6 cases(2.3%)in the non-prevention group,4(1.5%)superficial and 2(0.8%)deep infections were included.No evidence of differences in postoperative SSI rate between the two groups(P>0.05).This study also could not identify any statistically significant in clinical signs(redness/swelling,nonhealing incision,wound exudation,fever and positive bacterial culture)between the two groups(P>0.05).And there was no significant difference in the postoperative white blood cell count,postoperative neutrophil percentage and the mean temperature between the two groups(P>0.05);4.The SSI rate of the lower limbs in the SSI patients(11/15)was significantly higher than that in the other sites.No statistically significant difference was found in fracture location between the two groups(P>0.05).There was no significant difference in the number of SSI with postoperative time(P>0.05);5.There were 462 patients with risk factors.Patients who underwent closed fracture internal fixation of limbs with diabetes or ALB<35 g/L had a difference in the SSI rate between the two groups(P<0.05).Conclusion There is no relationship between SSI and perioperative antibiotic prophylaxis in patients undergoing closed limbs fracture internal fixation.Antibiotic prophylaxis does not be recommended in patients with related risk factors undergoing internal fixation of closed limbs fractures but may be considered in surgical patients with diabetes and albumin<35 g/L.