PROPHYLACTIC AND THERAPEUTIC USE OF ANTIBIOTICS IN ORTHOPAEDIC CLINICAL PRACTICE

Abstract

Objective: The purpose of this study was to evaluate the type and the dosage regimer the antibiotics administered prophylactically or curatively in six orthopaedic departments of «KAT» hospital.

Material-Method: Our study group consisted of 1231 patients who were hospitalized between September and November 2003. 1002 patients were treated surgically whilst 229 patients were managed conservatively. Among the patients who were operated 270 underwent THR or TKR, 306 patients were operated for NOF fracture, 195 patients were admitted because of long-bone fractures, 30 patients were operated for fracture or chronic deformity of the hand or the foot, 26 patients for open fractures, 52 patients underwent spine surgery and finally 53 patients were admitted for metal work removal.

Results: All patients were given antibiotics as prophylaxis for a period of 1–7 days 8 patients received antibiotics based on the cultures whilst 113 patients received empiric chemotherapy for some kind of infection. The microbiology lab recorded the microflora in every department and the percentage of resistance of the most important pathogens. Those were: 47% Gram(+) (45% staphylococcus) and 53% Gram(−). Of the identified staphylococci 44% were MR. MRSA-CNS was detected to be completely resistant to b-lactams and at a percentage up to 80% to amynoglycosides. The percentage of resistance of Pseudomonas was 55% to quinolones, 48% to aminoglycosides and 90% to b-lactams. We did notice that the use of the antibiotics was not based on a specific antibiotic policy and in a high percentage; the empirical use of chemotherapy was not documented on the laboratory data.

Conclusion: Taking into consideration the modern scientific data regarding the antibiotic treatment; the rational use of antibiotics in clinical practice requires the implementation of policies, the continuous education of the doctors as well as the intervention for proper prescriptions.