The present study aimed to compare the efficiency of prophylactic antibiotics for different durations (up to 24 and 72 hours) after surgery in preventing infection in lower limb fractures. According to separate analyses on infection-dependent variables, the outcome of prophylactic antibiotics administration in the first and the second groups was not significantly different, and the infection rates were similar in both groups.
According to studied relationships of variables with the incidence of infection in the two groups, the indices, such as age, sex, and body mass index, and clinical variables, including the duration of surgery and the amount of blood loss during surgery, showed no relationship between the incidence of infection in either group. Nevertheless, it should be noted that one case of infection in the first group was observed in a patient older than 60 years of age, probably due to age-related factors as issues affecting the infection rate, such as osteoporosis, and underlying diseases were excluded in the study.
Postoperative infection, especially in fracture surgery, is a main orthopedic problem that could severely affect the outcome of these operations (10, 11). Even though the impact of preventive administration of systemic antibiotics has been proven to prevent infection after the ORIF surgeries (9, 12), contradictory results have been reported regarding the duration of prophylactic antibiotic administration and its effectiveness. Minimizing the amount of post-surgical infection in these patients is vital in evaluating the effectiveness of prophylactic antibiotics. Due to the nature of this operation on tissues with low blood flow and external objects like metal plates, the antibiotic concentration would not be optimum in the surgical site. Thus, they might not help lower the possibility of postoperative infection (9, 13). Hence, various studies have been conducted on the efficacy of prophylactic antibiotics over different periods to reduce the risk of infection and its complications.
The prevalence of infection was reported as 1.42% in the present study, similar to Rahimi et al. , which reported an infection rate of 1.9%. The infection is a serious, difficult to treat complication of orthopedic surgeries, including the ORIF. It should be noted that the bone infection after surgery (Osteomyelitis) can lead to non-healing of the bone, and even amputation of the limb, in some cases (14). Balch et al. (15) found that prophylactic antibiotics can effectively reduce the risk of infection after orthopedic surgery. Infection treatment may be difficult, costly, and time-consuming for patients and physicians. Therefore, taking any measure to reduce the risk of infection after surgery is invaluable. There are many studies on finding preventive methods for reducing infection risk factors after surgery, among which antibiotic therapy has gained special attention. Mirza-Tolouei et al. (16) reported no significant difference between the 24- and 48-hour antibiotic therapy protocols for surgical site infection prevention, which was also confirmed in another study by Ondari et al. (17). These results were consistent with the present study. The present study also indicated that no significant difference was seen between the infection rate and duration of prophylactic antibiotic therapy.
Various studies have investigated surgical site infection risk factors, such as underlying infections, malnutrition, type of surgical procedures, and operating room conditions (18). Mathur et al. (19) found that prophylactic antibiotics for 24 hours were not significantly different from their use for a longer duration. This result was also consistent with the findings of the present study. Hawn et al. (20) reported that the probability of infection after orthopedic surgeries had no relationship with the duration of consumed prophylactic antibiotics, which confirmed the present study’s findings. The effectiveness of prophylactic antibiotics in reducing infections has been investigated in many studies (21), but the studied duration of consumed antibiotics was the strength of the present study. Significant points in the effectiveness of prophylactic antibiotics include the selection of antibiotics according to the type of surgery, the administration of the antibiotic 1 hour before surgery, and its discontinuation within 24 hours after the surgery. Suppose the prophylactic administration of antibiotics is not according to proper principles. In that case, it will lead to numerous complications, such as the disruption of the normal microbial flora of the body, the emergence of new antibiotic-resistant infections, increasing the risk of drug toxicity, and increasing unnecessary costs on the healthcare system (22). In a study by Rodriguez et al. (1), prophylactic antibiotics greatly reduced the infection. Prophylactic antibiotics can reduce the risk of wound infections and are routinely used in orthopedic surgeries. Despite their widespread use, there are still questions about the selection of prophylactic antibiotics in terms of duration and doses, and there is little evidence on the decision about prophylaxis duration (23).