Antibiotic usage with percutaneous K-wires

• Research type

  Research Study

• Full title

  The use of prophylactic antibiotics for percutaneous K-wires in orthopaedic surgery

• IRAS ID

  7880

• Sponsor organisation

  Great Western Hospital, Swindon

• Eudract number

  2009-011342-26

• ISRCTN Number

  N/A

• Clinicaltrials.gov Identifier

  N/A

• Research summary

  Infections in orthopaedics and traumatology can have serious consequences, especially where implants are present as infection can be difficult to eradicate. Bone and joint infection causes increased morbidity, hospital stay, and health care costs. Prevention of infection is therefore paramount. The use of prophylactic antibiotics is considered routine in some orthopaedic procedures such as joint replacement, spine surgery and major fracture fixation, but there are no clear guidelines about using prophylactic antibiotics for percutaneous K-wires in orthopaedic surgery. However, inappropriate use of antibiotics may not prevent postoperative infections, and may contribute to antibiotic resistance, with a risk of adverse reactions.A survey conducted to find out the current practice in UK revealed that only 50% orthopaedic surgeons routinely prescribe antibiotics with percutaneous K-wires.This study is an attempt to provide the scientific evidence to address this issue. Depending on the results it should prove possible to advocate that patients undergoing K-wire fixation are given antibiotic prophylaxis, or alternatively if there is no difference, then antibiotic use could be safely omitted for these patients, with subsequent healthcare cost savings and potentially reducing the risk of emergence of resistant strains of bacteria.We plan to enrol 200 adult orthopaedic patients requiring K-wire fixation of fractures, osteotomies or fusions. The most frequent operations are for hand or wrist fractures and toe fusions. They will be randomised to receive the current hospital antibiotic prophylaxis for metal implants, or to receive no antibiotics. Patients will be followed up in a nurse-led clinic where a standardised outcome form will be completed which includes a grading of severity of infection present. Typically patients are seen at 1 and 4 weeks post-operative, and the wire removed at the latter visit. The nurses are blinded as to whether the patient did or did not receive antibiotics.

• REC name

  South Central - Oxford C Research Ethics Committee

• REC reference

  09/H0606/90

• Date of REC Opinion

  4 Sep 2009

• REC opinion

  Favourable Opinion