Arch Hand Microsurg.  2022 Jun;27(2):149-153. 10.12790/ahm.21.0153.

Comparison of erythrocyte sedimentation rate and C-reactive protein in patients with distal radius fractures according to the prophylactic antibiotic period: 1 day versus 1 week

• Kim DG
• Kwack BH

• KMID: 2531921
• DOI: http://doi.org/10.12790/ahm.21.0153

Abstract

Purpose
Surgical site infection is a serious postoperative complication. Most surgical site infections after distal radius fracture (DRF) surgery are superficial and early-onset, and they can be prevented by prophylactic antibiotics. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are representative inflammatory markers. The aim of this study was to compare serial serum ESR and CRP levels in DRF patients according to the period of prophylactic antibiotic use.
Methods
A retrospective study was conducted on 46 patients with DRF treated with internal fixation. Twenty-two patients treated between September 2019 and March 2020 were in group A and 24 patients who underwent treatment from September 2020 to March 2021 comprised group B. The patients in group A were administered the first-generation cephalosporin for 1 week, as was customary. Group B received 1-day antibiotic prophylaxis. Surgery was performed by a single surgeon using volar locking plates. The surgical wounds and serum ESR and CRP levels were examined before surgery, 2 days after surgery, and 1 week after surgery and compared between the two groups.
Results
The CRP level, but not the ESR, changed significantly over time within each group. However, no statistically significant difference was observed between the two groups, and there were no surgical site infections.
Conclusion
The use of prophylactic antibiotics for 1 week had no significant effect on reducing ESR and CRP compared to 1-day prophylactic antibiotics in patients with DRFs.

Keyword

Radius fractures; Surgical wound infection; Antibiotic prophylaxis

Figure

• 

  Fig. 1. Erythrocyte sedimentation rate (ESR) values over time. Group A, the group administered antibiotic prophylaxis for 1 week; group B, the group administered antibiotic prophylaxis for 1 day.

• 

  Fig. 2. C-reactive protein (CRP) values over time. Group A, the group administered antibiotic prophylaxis for 1 week; group B, the group administered antibiotic prophylaxis for 1 day.

Reference

References

1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009; 37:387–97.

2. Agodi A, Auxilia F, Barchitta M, et al. Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study. Ann Ig. 2017; 29:422–30.

3. Backes M, Schepers T, Beerekamp MS, Luitse JS, Goslings JC, Schep NW. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2014; 38:767–73.

4. Lee JH, Lee JK, Park JS, et al. Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: a multicentre retrospective study. Int Orthop. 2020; 44:2057–67.

5. Metsemakers WJ, Kuehl R, Moriarty TF, et al. Infection after fracture fixation: current surgical and microbiological concepts. Injury. 2018; 49:511–22.

6. Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture-fixation devices. Injury. 2006; 37 Suppl 2:S59–66.

7. Costa ML, Achten J, Plant C, et al. UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. Health Technol Assess. 2015; 19:1–124.

8. Mathews AL, Chung KC. Management of complications of distal radius fractures. Hand Clin. 2015; 31:205–15.

9. Choi WS, Song JY, Hwang JH, Kim NS, Cheong HJ. Appropriateness of antibiotic prophylaxis for major surgery in Korea. Infect Control Hosp Epidemiol. 2007; 28:997–1002.

10. Sakong P, Lee JS, Lee EJ, et al. [Association between the pattern of prophylactic antibiotic use and surgical site infection rate for major surgeries in Korea]. J Prev Med Public Health. 2009; 42:12–20. Korean.

11. Ortega G, Rhee DS, Papandria DJ, et al. An evaluation of surgical site infections by wound classification system using the ACS-NSQIP. J Surg Res. 2012; 174:33–8.

12. Rundgren J, Enocson A, Järnbert-Pettersson H, Mellstrand Navarro C. Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients. BMC Musculoskelet Disord. 2020; 21:845.

13. Southwell-Keely JP, Russo RR, March L, Cumming R, Cameron I, Brnabic AJ. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res. 2004; (419):179–84.

14. Gatell JM, Garcia S, Lozano L, Soriano E, Ramon R, SanMiguel JG. Perioperative cefamandole prophylaxis against infections. J Bone Joint Surg Am. 1987; 69:1189–93.

15. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20:250–78.

16. Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008; 16:283–93.

17. Lee J, Lee Y, Jo YG, Kang SY, Bae KJ. Comparison of infection rates according to the period of prophylactic antibiotic use after surgery in patients with distal radius fractures. Arch Hand Microsurg. 2021; 26:224–30.

18. Subramanian P, Kantharuban S, Shilston S, Pearce OJ. Complications of Kirschner-wire fixation in distal radius fractures. Tech Hand Up Extrem Surg. 2012; 16:120–3.

19. Esposito J, Schemitsch EH, Saccone M, Sternheim A, Kuzyk PR. External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials. Injury. 2013; 44:409–16.

20. Margaliot Z, Haase SC, Kotsis SV, Kim HM, Chung KC. A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures. J Hand Surg Am. 2005; 30:1185–99.

21. Hargreaves DG, Drew SJ, Eckersley R. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires. J Hand Surg Br. 2004; 29:374–6.

22. Pepys MB. C-reactive protein fifty years on. Lancet. 1981; 1:653–7.

23. Palosuo T, Husman T, Koistinen J, Aho K. C-reactive protein in population samples. Acta Med Scand. 1986; 220:175–9.

24. Mok JM, Pekmezci M, Piper SL, et al. Use of C-reactive protein after spinal surgery: comparison with erythrocyte sedimentation rate as predictor of early postoperative infectious complications. Spine (Phila Pa 1976). 2008; 33:415–21.

25. Kang BU, Lee SH, Ahn Y, Choi WC, Choi YG. Surgical site infection in spinal surgery: detection and management based on serial C-reactive protein measurements. J Neurosurg Spine. 2010; 13:158–64.

26. Thelander U, Larsson S. Quantitation of C-reactive protein levels and erythrocyte sedimentation rate after spinal surgery. Spine (Phila Pa 1976). 1992; 17:400–4.

27. Edmiston CE, Krepel C, Kelly H, et al. Perioperative antibiotic prophylaxis in the gastric bypass patient: do we achieve therapeutic levels? Surgery. 2004; 136:738–47.

28. Kaufman MB. 2012 American Society of Health-System Pharmacists midyear clinical meeting & exhibition. P T. 2013; 38:119–20.

29. Zelenitsky SA, Ariano RE, Harding GK, Silverman RE. Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother. 2002; 46:3026–30.

30. Nam EY, Kim HB, Bae H, et al. Appropriateness of surgical antibiotic prophylaxis in a tertiary hospital. Korean J Nosocomial Infect Control. 2014; 19:64–70.