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- Talk
- 20/09/2023
- UK
WHiTE 8 Hip Fractures - Does More Antibiotic Result in Less Infection?
Description
In this presentation led by Nickil Agni, the WHITE 8 trial is introduced, which is an iteration of a broader randomized controlled trial aimed at addressing treatment protocols for hip fractures in older adults. The focus of this trial is on comparing single versus dual antibiotic loaded cement used in hemiarthroplasties to prevent surgical site infections (SSIs). Recent literature indicates a troubling correlation between hip fracture infections and high mortality rates, underscoring the need for effective prevention strategies.
Agni discusses the lack of consensus on the optimal type of cement and antibiotics for preventing infections, highlighting previous studies that suggested benefits from using high-dose dual antibiotic cements. The WHITE 8 trial is described as a pragmatic, multicenter, superiority trial involving nearly 5,000 patients over 60 years old, with a focus on assessing deep SSIs at 90 days post-surgery. Key methodology details, including participant selection and intervention groups (one receiving single antibiotic cement and the other dual antibiotic cement), are outlined. The primary outcome measured was the incidence of deep SSIs, while secondary outcomes included quality-of-life metrics and cost-effectiveness analysis.
The results revealed no significant difference in infection rates between groups, with deep SSI rates at 1.7% for single antibiotic versus 1.2% for dual antibiotic. This finding is critical, as it questions the cost-effectiveness of the dual antibiotic strategy, indicating a higher mean cost without significant clinical advantages. Overall, the trial's conclusions suggest that high-dose dual antibiotic loaded cement does not improve outcomes in preventing deep SSIs and may not be justifiable in the current economic climate of healthcare.