Antibiotic prophylaxis for the prevention of infection after major limb amputation.

BACKGROUND: Major limb amputation is often required by patients with a limited capacity to tolerate post-operative complications. Amputation stump infection is common and may necessitate re-amputation, potentially exposing a vulnerable patient to further serious complications. Effective antibiotic strategies should be employed to reduce wound infection after major amputation.
METHODS: Online databases were searched to identify studies regarding reduction in wound infection following major limb amputation. Only four randomised studies were identified comparing antibiotic prophylaxis with control; a further three evaluated the efficacy of specific antibiotics. Study design, end-points and outcome data were recorded. The data were too heterogeneous for formal meta-analysis.
RESULTS: Prophylactic antibiotics significantly reduced rates of stump infection in all studies, and were associated with a reduced rate of re-amputation in one. Where investigated, the type of antibiotic did not affect rates of infection. In non-randomised studies, infection with methicillin resistant Staphylococcus aureus (MRSA) increased the risk of complications and post-operative death.
CONCLUSION: It is agreed that prophylactic antibiotics are part of the standard of care for amputation surgery, and this is supported by limited, mostly historical-controlled data. Evolution of the bacterial threat means that future studies should assess the role and type of prophylaxis for patients with existing bacterial colonisation or infection.