gms | German Medical Science

Objectives: The administration of preoperative antimicrobial prophylaxis is a widely discussed topic and there is no consensus on the overall necessity. The purpose of this study was to evaluate the necessity of antimicrobial prophylaxis in elective hand surgery based on a prospective multicenter trial.

Methods: Between 2009 and 2012 we performed a multicenter trial in which patients that were receiving elective hand surgeries were categorized into an antibiotics or control group depending on the center they were enrolled in. Surgical site infections were defined according to the Centers for Diseases Control and Prevention.

Results and conclusion: In total 434 patients were included. 257 did not take antibiotics (control) and 177 received antibiotics at a mean age of 61.0 years. In the control group, comorbidities were more common with 23.7% (61/257) in comparison to the antibiotics group with 14.1% (25/177). Only one surgical site infection in each group was identified. One wound was opened surgically and an antimicrobial treatment was indicated in both cases. Additionally, in the control group we observed four complications versus three complications in the antibiotics group which required conservative management. No significant differences in the two cohorts in infection rate (0.006% vs. 0.003, chi-square 0.07, p>0.05) and complication rate (2.8% vs. 1.6%, chi-square 0.01, p>0.05) were found.

Our prospective multicenter trial shows no significant differences in infection and complication rate even in high-risk patients. These results may be applied in different surgical disciplines and a judicious use of antibiotics is necessary to reduce the risk of bacterial resistant.