Irsan Fahmi Almuhtarihan (2021) Penggunaan Antibiotik Profilaksis Terhadap Kejadian Infeksi Luka Operasi Pada Pasien Artroplasti (Scoping Review). Thesis thesis, UNIVERSITAS AIRLANGGA.

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Abstract

Background : The increase in the number of osteoarthritis patients results in increased demand for arthroplasty (Ackerman et al., 2019). This condition also increases the number of complications of arthroplasty, especially surgical site infection (SSI). One of the effective strategies in preventing surgical site infection is the use of appropriate prophylactic antibiotics (Bratzler et al., 2013) Objective : To identify and analyze various clinical research designs and risk factors associated with surgical site infection in arthroplasty, as well as information from clinical studies regarding factors affecting the effectiveness of prophylactic antibiotics in arthroplasty patients. Methods : A scoping review was conducted through the PubMed, Scopus, and Google Scholar databases within a publication range from January 2004 to August 2020. Study data are extracted and analyzed by a minimum of two reviewers in tabular form. Results : The search results found 2.419 articles, with 39 articles were included for further analysis. Based on the research design, 87 % of the articles (34 articles) was in the form of cohorts, while other studies were in the form of RCTs and case controls. Some conditions that have a higher SSI percentage are patients with diabetes mellitus (DM) and cardiovascular disease, male sex, overweight (obese), patients with an ASA score ≥ 3, and patients with an NNIS score ≥ 2. There were 24 different antibiotic regimens in this scoping review. Cefazolin was the most frequently used antibiotic in selected studies (15 studies (38.5%)) followed by vancomycin (8 studies (20.5%)). The antibiotics with the lowest SSI incidence ranges were fosfomycin mono-therapy (0%), cefazolin mono-therapy (0.20 - 16.05%), and vancomycin mono-therapy (0.27 - 3.88%). The correct antibiotic dose has a lower percentage of the SSI than the wrong antibiotic dose. Meanwhile, administration of prophylactic antibiotics within single dose or < 24 hours had a lower SSI percentage than administration of prophylactic antibiotics > 24 hours. Prophylactic antibiotics before incision also have a lower SSI percentage than prophylactic antibiotics after incision. There were no studies that discussed re-dosing of antibiotics in this scoping review. Conclusions : The accuracy of dosing and timing of antibiotic prophylaxis has an important role in minimizing the incidence of SSI. There is still a need for further research related to the timing of prophylactic antibiotics, especially regarding single dose or multiple dose antibiotics

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