Incidence and Risk Factors for Infection When Teicoplanin Is Included for Prophylaxis in Patients with Hip Fracture.

Background: Surgical site infection (SSI) rate after surgery for hip fracture is about 4%. The aim of the present study was to review the efficacy of dual prophylaxis using teicoplanin plus cefuroxime and risk factors for SSI.

Patients: Operations for hip fracture from 2012 to 2013 were retrospectively reviewed. Relevant information was gathered: Demographics, comorbidities, ASA score, laterality, type of fracture, type of surgery, d from admission to surgery, length of surgery, hemoglobin value at admission, urinary or respiratory infections, and the need for pre-operative, intra-operative, and post-operative red blood cell (RBC) transfusion. Prophylaxis consisted of cefuroxime and teicoplanin during the induction of anesthesia. U.S. Centers for Disease Control and Prevention (CDC) criteria for superficial and deep SSI were applied. Univariate and multivariable analysis were performed.

Results: Six hundred fifty-seven patients were included in the study. Thirteen (2.0%) SSI were identified, six superficial (0.9%), and seven deep (1.1%). Staphylococcus aureus was isolated in two infections (one superficial and one deep). The SSI rate was 2.4% in intra-medullary nails (n = 334), 1.4% in prostheses (n = 211), and 1.8% in other synthesis (n = 112). Parameters independently associated with SSI were: Intra-operative RBC transfusion (OR: 11.6, p = 0.002), length of surgery >120 min (OR: 4.5, p = 0.02), and having a urinary infection (OR: 4.28, p = 0.02).

Conclusion: Dual prophylaxis including cefuroxime and teicoplanin was associated with a 2% rate of SSI. Staphylococcus aureus caused only two SSIs. Reducing SSI is of utmost importance for patients' quality of life and to avoid additional cost of surgical procedures. Therefore, more experience with dual prophylaxis is needed to confirm our results.