Background

Due to the nationwide supply shortage of cefazolin in March 2019 in Japan, ceftriaxone was used as an alternative prophylaxis antibiotic agent. This retrospective study was designed to investigate the impact of cefazolin and ceftriaxone as a prophylactic antibiotic agent for surgical site infection (SSI) in orthopedic upper extremity surgery.

Methods

We used cefazolin for antibiotic prophylaxis to prevent SSI before March 2019. Because of cefazolin shortage, ceftriaxone was used as an alternative agent in our hospital. From April 2014 to May 2021, 2493 upper extremity surgeries were reviewed. The exclusion criteria in this study were as follows: patients aged under 16 years, those with an open wound, those with infectious diseases, those who underwent trigger finger surgery, and those who underwent percutaneous pinning surgery. The incidence of deep SSI was evaluated according to the Centers for Disease Control and Prevention guidelines.

Results

Among the 2493 eligible cases, 1674 were included in this study. In the cefazolin group, 1140 cases were included, whereas, in the ceftriaxone group, 534 cases were included. No significant differences in the demographic data of the patients were observed between the two groups. The incidence of deep SSI was 0.08% (1/1140 cases) in the cefazolin group and 1.1% (6/534 cases) in the ceftriaxone group, with a significant difference between the two groups (odds ratio, 12.9; p = 0.005).

Conclusions

This study indicated that the use of ceftriaxone instead of cefazolin after upper extremity surgery increases the risk of deep SSI.

中文翻译：

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头孢曲松与头孢唑林作为上肢骨科手术部位感染预防性抗生素的比较：2019年3月全国头孢唑林短缺情况

背景

由于2019年3月日本全国头孢唑林供应短缺，头孢曲松被用作替代预防性抗生素药物。这项回顾性研究旨在调查头孢唑林和头孢曲松作为预防性抗生素对骨科上肢手术中手术部位感染

方法

2019年3月之前，我们使用头孢唑林进行抗生素预防，以预防SSI。由于头孢唑林短缺，我们医院使用头孢曲松作为替代药物。从2014年4月到2021年5月，共回顾了2493例上肢手术。本研究的排除标准为：年龄16岁以下、有开放性伤口、患有传染病、接受扳机指手术、经皮钉扎手术的患者。深度 SSI 的发生率根据疾病控制和预防中心指南进行评估。

结果

在 2493 例符合条件的病例中，1674 例纳入本研究。头孢唑林组纳入1140例，头孢曲松组纳入534例。两组之间患者的人口统计数据没有观察到显着差异。头孢唑啉组和头孢曲松组的深度SSI发生率为0.08%（1/1140例）和1.1%（6/534例），两组之间存在显着性差异（优势比为12.9；p = 0.005  ） 。

结论

这项研究表明，上肢手术后使用头孢曲松代替头孢唑啉会增加深部 SSI 的风险。