These authors conducted a retrospective cohort study performed on 2,181 primary total knee arthroplasties (TKAs) and primary total hip arthroplasties (THAs) carried out from 2011 through 2016 at a suburban academic hospital with modern perioperative and infection-prevention protocols. Beginning in January 2015, extended oral antibiotic prophylaxis for 7 days after discharge was implemented for patients at high risk for PJI. The percentages of patients diagnosed with PJI within 90 days were identified and compared between groups that did and did not receive extended oral antibiotic prophylaxis.
Patients were categorized into 1 of 3 groups. Group A consisted of patients who were not at risk for PJI per protocol and therefore were not given extended oral antibiotic treatment; group B, patients at risk for PJI per protocol but not given extended oral antibiotic treatment because the protocol was not yet in place; and group C, patients at risk for PJI who received extended oral antibiotic prophylaxis per protocol.
The risk factors are listed below for groups B and C
The oral antibiotic protocol for high-risk patients consisted of cefadroxil, 500 mg twice daily for 7 days. Patients who tested positive for MRSA received Bactrim DS (sulfamethoxazole and trimethoprim) twice daily for 7 days or, if they were allergic to cephalosporins with documented anaphylaxis, 300 mg of clindamycin 3 times daily for 7 days.
The 90-day infection rates were 1.0% and 2.2% after the TKAs and THAs, respectively. High-risk patients without extended antibiotic prophylaxis were 4.9 (p = 0.009) and 4.0 (p = 0.037) times more likely to develop PJI after TKA and THA, respectively, than high-risk patients with extended antibiotic prophylaxis.
The adverse reactions to antibiotics are shown below
Comment: This study is of interest because it seems to run counter to the trend to minimize the use of antibiotics because of concerns related to increasing antibiotic resistance and the potential for antibiotic related problems, such as C. difficile infections.
The paper does not specify the organisms responsible for the infections observed - this would be of interest.
Finally, these data pertain to hip and knee arthroplasty. Different bacteria are found in shoulder periprosthetic infections (Propionibacterium and coagulase negative Staph), so the effectiveness of extended antibiotics in higher risk patients having shoulder arthroplasty requires independent assessment.
In any event, the identification and management of risk factors for infection is an important aspect of total joint arthroplasty and more studies of this type are needed. Balancing the risks and benefits of extended antibiotics in patients of increased risk is a priority.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
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