Abstract
BACKGROUND: Over 150 000 lower limb amputations (LLA) occur globally per year with surgical site infection (SSI) being a common complication. There is no clear UK national guidance or consensus regarding antibiotic usage post LLA and the extent of the problem is unknown since notification of vascular SSIs to the UK Health Security Agency is not compulsory. In our centre, co-amoxiclav was adopted as post-operative LLA prophylaxis for patients without penicillin allergy. OBJECTIVES: As part of antimicrobial stewardship activities, we aimed to reduce broad spectrum antibiotic usage. We present a data set detailing antibiotic usage post LLA; specifically focusing upon subsequent SSIs and Clostridioides difficile infection in patients receiving post-operative prophylactic antibiotics. METHODS: We retrospectively analysed all LLA from September 2020 to October 2023. A total of 132 patient records were identified from EPIC. We surveyed UK trusts to identify their antibiotic practice post LLA with 14 responses. RESULTS: Overall, 91% (n=120) received antibiotics post-operatively. There was a wide variety of antimicrobials and course lengths; the majority were prescribed co-amoxiclav (54%, n=65) and received a course length of 1–5 days (52%, n=62). Thirty-six percent (n=20) had an SSI of which 95% (n=19) received post-operative antibiotics. Eighty-five percent (n=17) had diabetes mellitus. Fifty-five percent (n=11) returned to theatre and one patient (who received antibiotics) died. A total of 4.5% (n=6) acquired C. difficile infection; 100% had antibiotics post-operatively with an average course length of 5.3 days prior to laboratory diagnosis. Sixty-six percent (n=4) received co-amoxiclav. The overall all-cause mortality was 24%; 5 died during admission and 26 died post-admission. Table 1 provides a detailed breakdown of antibiotic lengths and outcomes. Table 2 details pre-operative and post-operative LLA antibiotic guidance in 14 UK trusts. [Table: see text] [Table: see text] CONCLUSIONS: We have demonstrated the lack of standardized UK antimicrobial practice post LLA. Our data set enabled greater understanding of antimicrobial stewardship within LLA surgery and subsequently, we implemented formal post LLA guidance for antimicrobials; incorporating a more rational approach whilst minimizing the risk of C. difficile infection and continuing effective SSI cover. We will re-audit in the future to assess the effectiveness of this change.