These authors point out that when performing revision shoulder arthroplasty, surgeons do not have access to the results of intraoperative culture specimens and will, therefore, administer empiric antibiotics to cover for the possibility of deep infection until the culture results are finalized.
The purpose of their study was to report the factors associated with the initiation, modification, and adverse events of 2 different postoperative antibiotic protocols in a series of revision shoulder arthroplasties.
175 patients undergoing revision shoulder arthroplasty were treated with either a protocol of intravenous (IV) antibiotics if there was a high index of suspicion for infection (red protocol) or a protocol of oral antibiotics if the index of suspicion was low (yellow protocol). Antibiotics were withdrawn if cultures were negative and were modified as indicated if the cultures were positive.
On univariate analysis, factors significantly associated with the initiation of IV antibiotics were male sex (p < 0.001), history of infection (p < 0.001), intraoperative humeral loosening (p = 0.003), and membrane formation (p < 0.001).
175 patients undergoing revision shoulder arthroplasty were treated with either a protocol of intravenous (IV) antibiotics if there was a high index of suspicion for infection (red protocol) or a protocol of oral antibiotics if the index of suspicion was low (yellow protocol). Antibiotics were withdrawn if cultures were negative and were modified as indicated if the cultures were positive.
On univariate analysis, factors significantly associated with the initiation of IV antibiotics were male sex (p < 0.001), history of infection (p < 0.001), intraoperative humeral loosening (p = 0.003), and membrane formation (p < 0.001).
On multivariate analysis, male sex (p = 0.003), history of infection (p = 0.003), and membrane formation (p < 0.001) were found to be independent predictors of the initiation of IV antibiotics.
On the basis of preoperative and intraoperative characteristics, surgeons anticipated the culture results in 75% of cases, and modification of antibiotic therapy was required in 25%. The modification from oral to IV antibiotics due to positive culture results was made significantly more often in male patients (p < 0.001).
Adverse effects of antibiotic administration occurred in 19% of patients. The rates of complications were significantly lower in the patients treated with oral antibiotics and a shorter course of antibiotics (p < 0.001).
Comment: It is of interest that - using only the history and intraoperative findings - these surgeons were able to anticipate the results of intraoperative cultures in 3/4ths of the cases, enabling the optimal antibiotic protocol to be instituted at the time of surgery in these cases.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
Comment: It is of interest that - using only the history and intraoperative findings - these surgeons were able to anticipate the results of intraoperative cultures in 3/4ths of the cases, enabling the optimal antibiotic protocol to be instituted at the time of surgery in these cases.
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To see a YouTube of our technique for total shoulder arthroplasty, click on this link.
To see a YouTube of our technique for a reverse total shoulder arthroplasty, click on this link.
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