J Bone Jt Infect 2019; 4(6):254-263. doi:10.7150/jbji.39050

Review

Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts

Daniel Müller1*, Dominik Kaiser1*, Kati Sairanen2, Thorsten Studhalter3, İlker Uçkay2,3✉

1. Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
2. Unit of Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
3. Infectious Diseases and Infection Control, Balgrist University Hospital, Zurich, Switzerland
*equal contributions as first authors

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Citation:
Müller D, Kaiser D, Sairanen K, Studhalter T, Uçkay İ. Antimicrobial Prophylaxis for the Prevention of Surgical Site Infections in Orthopaedic Oncology - A Narrative Review of Current Concepts. J Bone Jt Infect 2019; 4(6):254-263. doi:10.7150/jbji.39050. Available from http://www.jbji.net/v04p0254.htm

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Abstract

The incidence of surgical site infections (SSIs) after elective tumour orthopaedic surgery in adults is higher than non-oncologic orthopaedic surgery. Their causative microorganisms and antibiotic susceptibilities are also different from the non-oncologic cases; with no apparent predictable microbiological patterns. Clinicians continue to struggle to tailor the optimal prophylactic regimen for the very heterogeneous group of tumour patients. Many clinicians thus prolong the first-and second-generation cephalosporin agents, while a minority chooses to broaden the antimicrobial spectrum by combination prophylaxis. The variability in current practices and surgical techniques is enormous, even within the same setting. The scientific literature lacks adequate retrospective case-studies and there is currently only one prospective randomized trial. In this narrative review, we discuss various perioperative antibiotic concepts in oncologic orthopaedic surgery, including a summary of the state-to-the-art, opinions and difficulties related to the different prophylactic strategies.

Keywords: orthopaedic surgery, oncology, antibiotic prophylaxis, prevention, review