McLaren AC, Lundy DW, et al.
The Journal of the American Academy of Orthopaedic Surgeons. Date of publication 2019 Aug 15;volume 27(16):e717-e720.
1. J Am Acad Orthop Surg. 2019 Aug 15;27(16):e717-e720. doi:
10.5435/JAAOS-D-18-00653.
AAOS Systematic Literature Review: Summary on the Management of Surgical Site
Infections.
McLaren AC(1), Lundy DW.
Author information:
(1)From Orthopaedic Surgery, University of Arizona, College of Medicine-Phoenix,
Phoenix, AZ (Dr. McLaren), and Resurgens Orthopaedics, Atlanta, GA (Dr. Lundy).
The purpose of this systematic review is to improve outcomes for the care of
surgical site infections by presenting the current best evidence on important
diagnostic and care issues. The findings led to ten recommendations and five
consensus statements that address diagnosis and treatment of orthopaedic surgical
site infections. There is strong evidence to supports anemia, obesity, HIV/AIDS,
depression, dementia, immunosuppressive medications, duration of hospital stay,
history of alcohol abuse, and history of congestive heart failure as factors that
increased the risk of infection, some of which are modifiable before surgical
intervention. Diagnostically, synovial fluid and tissue cultures were found to be
strong "rule-in" tests for the diagnosis of infection, but negative synovial
fluid and tissue cultures do not reliably exclude infection. C-reactive protein
was found to be a strong rule-in and rule-out marker for patients with suspected
surgical site infections. Therapeutically, only for patients with retained
implants, antimicrobial protocols of 8 weeks of duration were found to be
associated with outcomes that are not inferior to outcomes from protocols of 3-
to 6-month duration. Also only for patients with retained implants, rifampin,
used as a second antimicrobial, increases the probability of treatment success
for staphylococcal infections. The surgical site infection work group identified
a lack of high-level outcomes data, highlighting the need for high-quality
clinical trials in the treatment of surgical site infections.
DOI: 10.5435/JAAOS-D-18-00653
PMID: 30601372 [Indexed for MEDLINE]
