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. 2018 Nov 15:11:61.
doi: 10.1186/s13047-018-0303-0. eCollection 2018.

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Mr Ravi Krishān Modha  1 , Chris Morriss-Roberts  1 , Madeleine Smither  1 , Jonathan Larholt  1 , Ian Reilly  1
Affiliations

Antibiotic prophylaxis in foot and ankle surgery: a systematic review of the literature

Mr Ravi Krishān Modha et al. J Foot Ankle Res. .

Abstract

Background: With the advent of bacterial resistance, it is important now more than ever to evaluate use of antibiotic chemoprophylaxis in foot and ankle surgery. Within this area of the body there may be less dissection, surgery time with smaller incisions and importantly smaller sizes of implanted fixation as compared to other bone and joint procedures. Our objective was to systematically evaluate the quality of evidence behind existing guidelines.

Methodology: A systematic literature search was performed: MEDLINE, CINHAL, EMBASE and the Cochrane library from 1990 up to March 2018. To avoid omitting any studies on the subject, Google Scholar was also used. The inclusion criterion were studies exploring perioperative antibiotic use, postoperative infection rates in elective foot and ankle surgery and studies associated with this subject evaluating antibiotic use in clean elective foot and ankle surgery. The exclusion criterion being studies upon contaminated or dirty surgery or those which were inclusive of procedures proximal to the foot and ankle.

Results: Overall 11 studies met the inclusion criteria. From the grading of evidence, 2 level one and 4 level two studies were recognised. These studies ranked relatively highly in comparison to 5 studies that were graded as level three and level four tiers of evidence. Results of SSI rates found within this systematic review ranged from 0% to 9.4% of overall postoperative infections encountered after foot and ankle surgery in the studies analysed.

Conclusion: Whilst fragmented, aspects of antibiotic chemoprophylaxis are established fields in elective surgery with a growing body of evidence. Evidence for antibiotic use however, specifically within elective foot and ankle surgery, is lacking. This systematic review is a seminal paper which delivers an impression of the most influential literature within the field of foot and ankle surgery, with the aim being to entice conclusions and guide future research.

Keywords: Antibiotic chemoprophylaxis; Antibiotic prophylaxis; Biofilm; Foot and ankle surgery; Foot surgery; Orthopedic surgery; Podiatric surgery; Postoperative infection; Surgical site infection.

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Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors received no financial support for the research, authorship, and/or publication of this article.Not applicable.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
– Flow Diagram of screening process
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