ABSTRACT

RELATIONSHIP BETWEEN PROPHYLAXIS ANTIBIOTIC

ADMINISTRATION TIMING BEFORE TOURNIQUET INFLATION ON
ORTHOPAEDIC SURGERY WITH ANTIBIOTIC CONCENTRATION
ON SURGICAL WOUND SWAB AND MICROBACTERIAL CEFAZOLIN
RESISTANCE
Hafidz Addatuang Ambong1, Ketut Siki Kawiyana2, K. G. Mulyadi Ridia2
Department of Orthopaedics and Traumatology, Faculty of Medicine Universitas
Udayana – Sanglah General Hospital Denpasar, Indonesia,
1
Resident, 2Consultant

Introduction
Tourniquet is one of the modality commonly used in orthopaedic surgeries.
However its use is sometimes correlated with suboptimal prophylaxis antibiotic
delivery to surgical site. Previous researches have tried to find the optimal timing
of the antibiotic administration to produce highest possible concentration of
antibiotic in the surgical site. Cefazolin has long been used as the prophylaxis
antibiotic. The purpose of this research is to determine the optimal timing for
prophylaxis antibiotic administration on surgery using tourniquet to produce
maximum antibiotic concentration on the surgical site, and to determine antibiotic
sensitivity of the bacteria cultured form the surgical site.
Method
This research used analytic cross-sectional study design, using secondary data
from patient’s medical record. A total of 24 samples are gathered using
consecutive sampling method, who then are divided into three group. Inclusion
criteria: orthopaedic surgery using tourniquet, and the use of cefazolin as
prophylaxis antibiotic. Exclusion criteria: history of infection by cefazolin-
resistant bacteria, history of chronic osteomyelitis on surgical site, and allergy to
cefazolin.
Result
From the three sample group, group that receive cefazolin 30-45 minutes before
tourniquet inflation gives the highest antibiotic concentration on the surgical site
compared to 45-60 minutes and >60 minutes group (p=0.000). While on the
antibiotic sensitivity test, no bacteria was grown on the surgical site swab sample,
so the test cannot proceed.
Discussion
This research has shown that the cefazolin administration 30-45 minutes prior to
tourniquet inflation resulted in the highest antibiotic concentration on the surgical
site. This result was in line with previous researches that concluded optimal
timing for antibiotic administration on surgery using tourniquet is 30-60 minutes
prior to inflation. On the antibiotic sensitivity test, absence of bacteria growth on
all samples indicated prophylaxis antibiotic administration on reccomended time
frame.
Conclusion
The optimal timeframe for prophylaxis antibiotic administration is 30-45 minutes
prior to tourniquet inflation. Surgical site bacterial growth can be prevented by
antibiotic administration on the reccomended timeframe.
Keywords: Prophylaxis antibiotic, Tourniquet, Orthopaedic surgery, Cefazolin,
Vitec2 Compact