Do Extended Oral Postoperative Antibiotics Prevent Early Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Primary Total Joint Arthroplasty?

Carender, Christopher N.; DeMik, David E.; Glass, Natalie; Noiseux, Nicolas; Brown, Timothy S.; Bedard, Nicholas A.

doi:10.1016/j.arth.2021.03.018

Cited by 26 publications

(27 citation statements)

References 22 publications

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“…We conducted a stratified analysis of obese people undergoing TJA surgery, and still did not observe any improvement in the primary outcome measures of longer antibiotic prophylaxis. Likewise, surgeons in the Midwestern United States began to prescribe extended oral antibiotics of 7–14 days to morbidly obese patients (BMI≥40 kg/m 2 ) in early 2018 25 . Similar to our results, prolonged oral antibiotics in patients with primary THA or TKA did not reduce the incidence of wound complications and early PJI.…”

Section: Discussionsupporting

confidence: 80%

“…Compared to patients with CKD stage I/II or without CKD, patients with CKD stage III-IV had a higher chance of any postoperative complications (OR, 2.63; p < 0.0001). 33 In contrast, Carender et al 25 performed a univariate analysis for incisional complications and did not find an enhanced risk in patients with chronic renal insufficiency.…”

Section: Discussionmentioning

confidence: 94%

“…Furthermore, patients who received short course and longer course of perioperative antibiotics showed no statistical difference in our cohort for postoperative complications. Similarly, Carender et al 25 retrospectively evaluated 650 morbidly obese patients who received primary TKA or THA and found that prolonged antibiotic prophylaxis could not reduce the occurrence of incisional complications and early PJI.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative complications were defined as one or more of the following after discontinuing antibiotic prophylaxis: system complications, incisional complications and PJI. Incisional complications were defined as one or more of the following after discontinuing antibiotic prophylaxis: incision dehiscence, persistent surgical drainage for more than 72 h after the surgical procedure, newly prescribed antibiotics for SSI 25 . And PJI diagnosis was established according to the Musculoskeletal Infection Society (MSIS) criteria 12,26 …”

Section: Methodsmentioning

confidence: 99%

“…Incisional complications were defined as one or more of the following after discontinuing antibiotic prophylaxis: incision dehiscence, persistent surgical drainage for more than 72 h after the surgical procedure, newly prescribed antibiotics for SSI. 25 And PJI diagnosis was established according to the Musculoskeletal Infection Society (MSIS) criteria. 12,26…”

Section: Definitionmentioning

confidence: 99%

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Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population

Shang

Wang

Gong

et al. 2021

Clinical Pharmacy Therapeu

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What is known and objective Prolonged antibiotic prophylaxis after total joint arthroplasty (TJA) may not assist in minimizing postoperative complications, however, data based on the Chinese population have been limited. The purpose of this study is to investigate the effect of antibiotic prophylaxis on postoperative complications after TJA in Chinese patients. Methods We retrospectively reviewed 990 patients undergoing elective primary TJA surgery from January 2016 to June 2019. Patients who received a short course (≤3 days) of antibiotic prophylaxis were compared with those who received a longer course (>3 days). Logistic regression analysis and subgroup analysis were performed to control for potential confounders. Beyond that, survival analysis was used to determine the cumulative incidence of postoperative complications. Results and discussion Follow‐up to 12 months after surgery, the prevalence of system complications in the longer course group and the short course group were 5.1% and 3.9%, respectively (p = 0.451). Similarly, no statistical differences in incisional complications (1.5% vs. 1.8%, p > 0.999) and periprosthetic joint infection (PJI) (1.0% vs. 1.0%, p > 0.999) were observed between the two groups. After performing logistic regression analysis and survival analysis, no potential association was found between the course of antibiotic prophylaxis and postoperative complications. In addition, prolonged antibiotic prophylaxis conferred no benefit for high‐risk obese patients. What is new and conclusion Extended antibiotic prophylaxis did not result in a statistically significant and clinically meaningful reduction in postoperative complications. Therefore, we recommended that the duration of antibiotic prophylaxis in TJA should be shortened to 3 days or less in the Chinese population.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Definitionmentioning

confidence: 99%

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Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population

Shang

Wang

Gong

et al. 2021

Clinical Pharmacy Therapeu

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Duration of cefazolin prophylaxis did not impact infection risk in a murine model of joint arthroplasty

Karau,

Alarcon Perico,

Guarin Perez

et al. 2024

Journal Orthopaedic Research

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To minimize periprosthetic joint infection (PJI) risk, some clinicians prescribe extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA). Given the limited evidence supporting EAP, we sought to evaluate impact of prophylactic antibiotic duration on PJI risk in a murine TJA model. A titanium prosthesis was implanted into the proximal tibia of 89 mice and inoculated with 102 colony forming units (cfu) of Staphylococcus aureus Xen36. Control mice (n = 20) did not receive antibiotics. Treated mice received either 24 h (n = 35) or 4 days (n = 34) of cefazolin prophylaxis. Cultures were obtained from the prostheses, tibia, femur, and knee tissues 3 weeks after surgery. All mice in the control group developed PJI. Both prophylaxis regimens reduced the rate of PJI relative to the control, with only 2/35 mice in the 24‐h cohort (p < 0.0001) and 1/34 in 4‐day cohort developing PJI (p < 0.0001). CFU counts from the prostheses, bone and knee tissues were reduced for the 24‐h and 4‐day prophylaxis cohorts relative to the control (p < 0.0001 for both). There was no difference in rates of PJI or CFU counts between the two prophylaxis cohorts (p = 0.58). Prophylactic cefazolin profoundly reduced rates of PJI in a murine model of TJA in which all control animals developed PJI. Extending cefazolin prophylaxis duration from 24 h to 4 days did not result in improved PJI rates or decreased bacterial loads in infected cases. While these results strongly support use of antibiotic prophylaxis for TJA, EAP did not appear to add benefit in the described mouse model.

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Cefadroxil-Induced Clostridium difficile Infection Following Total Knee Arthroplasty

Angerett¹,

Ferguson²,

Kahan³

et al. 2022

Arthroplasty Today

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Do Extended Oral Postoperative Antibiotics Prevent Early Periprosthetic Joint Infection in Morbidly Obese Patients Undergoing Primary Total Joint Arthroplasty?

Cited by 26 publications

References 22 publications

Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population

Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population

Duration of cefazolin prophylaxis did not impact infection risk in a murine model of joint arthroplasty

Cefadroxil-Induced Clostridium difficile Infection Following Total Knee Arthroplasty

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