Effect Of Antibiotic Prophylaxis With Cefuroxime On Bacteriologic Quality Of Intra- And Postoperatively Processed Wound Blood In Hip Joint Arthroplasty

Objective: Investigation of the bacteriological quality of processed wound blood in orthopedic hip surgery depending on antibiotic prophylaxis or not. Design: Prospective randomized study after approval of the Ethics Committee. Setting: Operation theatre/intensive care unit of an Orthopedic University Clinic. Patients: 40 patients underwent first hip arthroplasty under regional anesthesia. 20 received as antibiotic prophylaxis cefuroxime 1.5 g single shot, 20 not. Interventions: Preoperative collection of autologous plasma (2 x 900 ml),normovolemic hemodilution (15 ml/KG), intra- and postoperative mechanical autotransfusion (CellSaver(R)/Autotrans(R)). A quantitative bacteriological study was performed from the collecting bag (Vacufix(R)), wound drainage blood and processed red blood cell concentrates (PRBCC), using a pour plate technique and broth culture enrichment (Bactec(R) bottles). Examination after 2 and 7 days. Results: Maximally 1 CFU/ml (colony-forming unit) of bacteria was isolated from 8 Vacufix(R) bags of the control group (8/20), in contrast to no growthin the antibiotic group (0/20; p<0.005). Wound drainage blood was found sterile in all patients. In 8 PRBCC of the control group (8/20) bacteria were identified in a concentration of <1 (5x), 1-2 (2x), and 130 (1x) CFU/ml. In the cefuroxime group only 3/20 showed bacterial growth <1 CFU/ml. Conclusions: Bacterial contamination of processed wound blood never caused wound or systemic infections. Antibiotic prophylaxis (cefuroxime) led to sterility in the Vacufix(R) collecting bac and reduction of bacterial growth in the PRBCC.