STRICT PEROPERATIVE ANTIBIOTIC ADMINISTRA TION IN PROPHYLAXIS OF SEPSIS FOLLOWING HIP AND KNEE ARTHROPLASTIES

Orthopaedic prosthetic surgery requires a perioperative antibioprophyl axis in order to limit the infections rates. However, its realisation is still debatable, specially according to its duration. The current s tudy was performed in order to assess the efficacy of a strict peroper ative administration of cefamandol in 1989 or cloxacillin in 1990 in t his indication. This antibioprophylaxis was given in 736 hip and knee arthroplasties (368 in 1989 and in 1990). Patients having a high septi c risk (diabetics, immunodepressed, prothesis replacement) were exclud ed. An injection was administered immediately before the surgical proc edure, and repeated when the surgery lasted more than 2 hours. Superfi cial wound and prosthetic infections were then evaluated within one ye ar according to the CDC criteria. The total infection rate was 3,1 %, with 1,1 % of prothetic infection (5 cases in 1989, 3 cases in 1990) a nd 2% of wound infections (6 cases in 1989 and 9 in 1990). Four S aure us and 4 coagulase negative staphylocci were responsible of the prosth etic infections, one of them being methicillin-resistant. This study d emonstrates that strictly peroperative administration of antibiotic is safe in order to prevent post-operative infection in arthroplastic su rgery. No difference was established in infection rates after cefamand ol or cloxacillin administation.