Background: Although routine antibiotic prophylaxis immediately preceding an orthopedic surgery has become the standard of care in most cases, this practice is poorly defined in hand surgery. The purpose of this analysis is to review the most current literature of antibiotic use in hand surgery. Methods: A careful review of the literature regarding routine antibiotic prophylaxis in hand surgery was made. Current relevant resources were used in the construction of this review. Results: There is a mixed consensus on the role for prophylactic antibiotics in hand surgery with some resources and data showing support and others opposed. Conclusions: Based on the current literature, the authors recommend the following patient characteristics not receive antibiotics: clean hygienic patients, without autoimmune disease, and those not taking steroid medication. Surgical characteristics that would render prophylaxis unnecessary include those without hardware, those without reasonable risk of hematoma formation, or those performed at an ambulatory surgery center as opposed to a large hospital. However, the decision should be made on a case-by-case basis weighing the evidence presented.
American Academy of Orthopaedic Surgeons. Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty. http://www.aaos.org/about/papers/advistmt/1027.asp. Published 2004. Accessed June 6, 2016.
3.
ArcherGL.Alteration of cutaneous staphylococcal flora as a consequence of antimicrobial prophylaxis. Rev Infect Dis. 1991;13:S805-S809.
4.
BertholdEGeborekPGulfeA.Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures. Acta Orthop. 2013;84(5):495-501.
5.
BlairWFShurrDGBuckwalkerJA.Metacarpophalangeal joint implant arthroplasty with a Silastic spacer. J Bone Joint Surg Am. 1984;66:365-370.
6.
BotteMJDavisJLWRoseBAet al. Complications of smooth pin fixation of fractures and dislocations in the hand and wrist. Clin Orthop Relat Res. 1992;276:194-201.
7.
BoydRJBurkeJFColtonT.A double-blind clinical trial of prophylactic antibiotics in hip fractures. J Bone Joint Surg Am. 1973;55:1251-1258.
8.
BykowskiMRSivakWNCrayJet al. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am. 2011;36(11):1741-1747.
9.
Centers for Disease Control and Prevention (CDC). Reduced susceptibility of Staphylococcus aureus to vancomycin—Japan, 1996. MMWR Morb Mortal Wkly Rep. 1997;46:624-626.
10.
CharnleyJ.Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res. 1972;87:167-187.
11.
ClassenDCEvansRSPestootnikSLet al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326:281-286.
12.
CummingsP.Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. 1994;23:535-540.
13.
DhallSAlamatRCastroAet al. Tobacco toxins deposited on surfaces (third hand smoke) impair wound healing. Clin Sci (Lond). 2016;130:1269-1284.
14.
DunnJCLanziJKusnezovNBaderJet al. Predictors of length of stay after elective total shoulder arthroplasty in the United States. J Shoulder Elbow Surg. 2015;24(5):754-759.
15.
EggimannPPittetD.Infection control in the ICU. Chest. 2001;120:2059-2093.
16.
FisichellaLFengaDRosaMA.Surgical site infection in orthopaedic surgery: correlation between age, diabetes, smoke and surgical risk. Folia Med (Plovdiv). 2014;56(4):259-263.
17.
FormainiNJacobPWillisLet al. Evaluating the use of preoperative antibiotics in pediatric orthopaedic surgery. J Pediatr Orthop. 2012;32(7):732-735.
18.
FryDE.Surgical site infections and the Surgical Care Improvement Project (SCIP): evolution of national quality measures. Surg Infect (Larchmt). 2008;9(6):579-584.
19.
FulkersonEDella ValleCJWiseBet al. Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. J Bone Joint Surg Am. 2006;88:1231-1237.
20.
FurnesAHavelinLIEngesaeterLBet al. Quality control of prosthetic replacements of knee, ankle, toe, shoulder, elbow and finger joints in Norway 1994. A report after the first year of registration of joint prostheses in the national registry. Tidsskr Nor Laegeforen. 1996;116:1777-1781.
21.
GaribaldiRACushingDLererT.Predictors of intraoperative-acquired surgical wound infections. J Hosp Infect. 1991;18:289-298.
22.
GreenSA.Complications of pin and wire external fixation. Instr Course Lect. 1990;39:219-228.
23.
GustiloRBAndersonJT.Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-458.
24.
GutowskiCJZMistowskiBMClydeCTet al. The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement. Bone Joint J. 2014;96(1):65-69.
25.
HaleyRW.Nosocomial infections in surgical patients: developing valid measures of intrinsic patient risk. Am J Med. 1991;91:145S-151S.
26.
HaleyRWCulverDHMorganWMet al. Identifying patients at high risk of surgical wound infection. Am J Epidemiol. 1985;121:206-215.
27.
HarbarthSSamoreMHLichtenbergDet al. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation. 2000;101:2916-2921.
28.
HarnessNGInacioMCPfeilFFet al. Rate of infection after carpal tunnel release surgery and effect of antibiotic prophylaxis. J Hand Surg Am. 2010;35(2):189-196.
29.
HobermanAParadiseJLBurchDJet al. Equivalent efficacy and reduced occurrence of diarrhea from a new formulation of amoxicillin/clavulanate potassium (Augmentin) for treatment of acute otitis media in children. Pediatr Infect Dis J. 1997;16(5):463-470.
30.
JaindlMOberleitnerGEndlerGet al. Management of bite wounds in children and adults—an analysis of over 5000 cases at a level I trauma centre. Wien Klin Wochenschr. 2016;128(9-10):367-375.
31.
KaiserAB.Antimicrobial prophylaxis in surgery. N Eng J Med. 1986;315:1129-1138.
32.
LidwellOMLowburyEJWhyteWet al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomized study. Br Med J (Clin Res Ed). 1982;285:10-14.
33.
LindgrenL.Postoperative orthopaedic infections in patients with diabetes mellitus. Acta Orthop Scand. 1973;44:149-151.
34.
LineweaverWCHillMKBunckeGMet al. Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery. Ann Plast Surg. 1992;29:238-244.
35.
LipiraABSoodRFTatmanPDet al. Complications within 30 days of hand surgery: an analysis of 10,646 patients. J Hand Surg Am. 2015;40(9):1852-1859.
36.
LiuniFMRugieroCFeolaMet al. Impaired healing of fragility fractures in type 2 diabetes: clinical and radiographic assessments and serum cytokine levels. Aging Clin Exp Res. 2015;27(1):S37-S44.
37.
MenonTJThjellesenDWrobleskiBM.Charnley low-friction arthroplasty in diabetic patients. J Bone Joint Surg Br. 1983;65:580-581.
38.
MenovskyTBartelsRHvan LindertELet al. Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures. Hand Surg. 2004;9(1):35-38.
39.
MishrikiSFLawDJWJefferyPJ. Factors affecting the incidence of postoperative wound infection. J Hosp Infect. 1990;16:223-230.
40.
MorreyBFAdamRBryanRS.Infection after total elbow arthroplasty. J Bone Joint Surg Am. 1983;65:330-338.
41.
MunnsJJAwanHM.Trends in carpal tunnel surgery: an online survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2015;40(4):767-771.
42.
PattersonJSimmonsBP.Outcomes assessment in carpal tunnel syndrome. Hand Clin. 2002;18:359-363.
43.
PlattAJPageRE.Post-operative infection following hand surgery. Guidelines for antibiotic use. J Hand Surg Br. 1995;20(5):685-690.
44.
PossRThornhillTSEwaldFCet al. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984;182:117-126.
45.
RitterMAEitzenHEFrenchMLVet al. The effect that time, touch and environment have upon bacterial contamination of instruments during surgery. Ann Surg. 1976;184:642-644.
46.
RizviMBilleBHoltomPet al. The role of prophylactic antibiotics in elective hand surgery. J Hand Surg Am. 2008;33(3):413-420.
47.
SaxonABeallGNRohrASet al. Immediate hypersensitivity reactions to beta-lactam antibiotics. Ann Intern Med. 1987;107:204-215.
48.
SchoenfeldAJHerzogJPDunnJCet al. Patient-based and surgical characteristics associated with the acute development of deep venous thrombosis and pulmonary embolism after spine surgery. Spine (Phila Pa 1976). 2013;38(21):1892-1899.
49.
SolenskyREarlHGruchallaR.Clinical approach to penicillin-allergic patients: a survey. Ann Allergy Asthma Immunol. 2000;84(3):329-333.
50.
SwansonAB.Flexible implant arthroplasty in the proximal interphalangeal joint of the hand. J Hand Surg Am. 1985;10:796-805.
51.
TostiRFowlerJDwyerJet al. Is antibiotic prophylaxis necessary in elective soft tissue hand surgery?Orthopedics. 2012;35(6):e829-e833.
52.
WatermanBRDunnJCBaderJOet al. Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors. J Shoulder Elbow Surg. 2015;24(1):24-30.
53.
WilsonMGKelleyKThornhillTS.Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990;72:878-883.
54.
ZwiebelSBeckerD.Risk of postoperative infection following carpal tunnel release in patients with diabetes mellitus: a review of 658 surgeries. J Hand Surg. 2014;39(9):e44-e45.
