Prophylactic antibiotic regimens lack evidence of PARITY

By Lynda Williams

Results from the PARITY study highlight the need for consensus in the prevention of infection in patients undergoing endoprosthetic limb reconstruction following sarcoma.

"The current lack of guidelines for the prescription of prophylactic antibiotics in Musculoskeletal Tumor Surgery has left Orthopaedic Oncologists with varying opinions and practices," say Khaled Hasan (McMaster University, Hamilton, Ontario, Canada) and co-authors in BMC Musculoskeletal Disorders.

"The lack of current evidence and strong surgeon support for participating in a definitive study provides strong rationale for clinical trials."

The PARITY (Prophylactic Antibiotic Regimens in Tumor Surgery) team asked 97 surgeons to complete an online survey regarding their preferred prophylactic antibiotics for patients undergoing musculoskeletal tumor surgery.

Overall, 72 surgeons completed the survey, the majority of whom were in academic positions (86%), had completed orthopedic oncology fellowship training (95%), and had over 5 years' experience (96%).

Ninety percent of respondents stated that prophylactic antibiotics are important to prevent infection after long bone sarcoma reconstruction, but opinions were split on the best timing and type of antibiotics to use.

Preoperative antibiotics were considered the single most important step in preventing infection by 46% of surgeons, whereas 50% believed pre- and postoperative antibiotics were equally important. Antibiotics were discontinued after 24 hours by 36% of surgeons and after 48 hours by 18%, while 41% continued treatment until suction drain removal.

Gram-positive antibiotics were considered adequate by 73% of respondents, 11% prescribed both Gram-positive and -negative drugs, and 4% prescribed vancomycin. When asked to prescribe a first-generation cephalosporin, recommended dosages were 1 g (13%), 2 g (33%), and 2 g only for patients over 80 kg (53%).

Of concern, 43% of surgeons believe there is no evidence to guide antibiotic prophylaxis for patients undergoing long bone reconstruction, Hasan et al note.

Indeed, over 80% of surgeons stated there was a need for more research into the outcomes of different prophylactic antibiotic drugs and regimens, and 90% said they would alter their practice in the light of randomized controlled trial results. Just a 10% absolute risk reduction in infection would offer significant clinical benefit, the surgeons said.

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