Medidas para la prevención de la infección en la artroplastia de rodilla : prácticas habituales y evidencias
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Climent Peris, Vicente; Mifsut Miedes, Damian; Álvarez Llanas, A.; Strauch, M.; Baeza Oliete, J.; Valero Queralt, M.A.; Ferraro Esparza, L.; Martínez Algarra, J.C; Gilabert, E.; Gargallo, E.
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Aquest document és un/a article, creat/da en: 2017
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Infection after knee arthroplasty is one of the most feared complications and routine measures are applied to prevent it. The objective of this study is to identify which are the measures applied by the surgeons of the Valencian Community (CV) and know if the scientific evidence supports them or not. Methods. A descriptive cross-sectional observational study based on a survey of 64 surgeons and bibliographic searches on the aspects included in the survey were conducted. Results. 18.8% of the surgeons perform screening for SARM carriers and decolonization. 98.4% use cefazoline and 1.6% cefuroxime as antibiotic prophylaxis. With respect to the duration of antibiotic prophylaxis, 51% of surgeons administer three doses (24 hours prophylaxis), 23.4% use 2 doses and 17.2% of them use only one dose. 67.2% use 2% alcoholic chlorhexidine gluconate solution for surgical site preparation and 71.9% use adhesive incision drapes. Routine cement with antibiotics is used by 65.6% of respondents. The current scientific evidence supports antibiotic prophylaxis as performed by 100% of respondents; however there is no evidence for the superiority of the preparation of the skin with alcoholic chlorhexidine versus other antiseptics. There is also no evidence to support the use of adhesive incision drapes or the use of cement with antibiotics in a routine manner. Conclusions. It would be advisable for the CV surgeons to avoid the use of incision adhesive drapes and the application of cement with antibiotics in all cases. The preparation of the skin with alcoholic chlorhexidine does not seem to be more effective than other antiseptics in orthopaedic surgery. The screening of SAMR carriers and their decolonization seems to reduce the infection rate; its use can be recommended today, but studies with the largest number of patients that confirm their benefit are needed.
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