Orthopaedic antimicrobial prophylaxis in the United Kingdom

Using the Freedom of Information Act, a five-point questionnaire was sent to all NHS Trusts in the United Kingdom: Eighty two per cent of NHS Trusts in the UK who had an orthopaedic department replied. The top three antimicrobial prophylaxis regimes in orthopaedic surgery were cefuroxime alone (trauma 48%, elective 56%), flucloxacillin plus gentamicin (trauma 16%, elective 19%) and co-amoxiclav alone (trauma 10%, elective 5.6%). Forty nine per cent of Trusts involved changed antimicrobial prophylaxis regimes between August 2005 and July 2008, to restrict the use of cefuroxime. There was a 74% difference in C. difficile rates in Trusts who use cefuroxime when compared to any other antimicrobial regime. In Trusts that changed away from cefuroxime, there was a 33% reduction in C. difficile rates. Clostridium difficile rates were six times higher in trauma than elective surgery across the UK. Few Trusts (trauma 7.7%, elective 7.6%) used antimicrobial prophylaxis regimes that have a low-risk association with C. difficile infection.