Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty

Abstract

Infection is a rare, serious complication following total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research.

Identifying Common Pathogens in Periprosthetic Joint Infection and Testing Drug‐resistance Rate for Different Antibiotics: A Prospective, Single Center Study in Beijing

“…We also included patients with aseptic loosening because some patients might have low‐grade infections in this group. Gram‐positive bacterium is still the most common pathogenic bacteria in PJI, accounting for over 50% of cases, and in our study the proportion of isolated G+ bacteria was 86.9% (60/69); Staphylococcus epidermidis and Staphylococcus aureus were the largest in number.…”

“…Even so, we believe that our study could provide some information on current treatment of PJI. Previous studies have found that decolonization plays an essential role in postoperative infection, and the use of prophylactic antibiotics against the decolonization might decrease the rate of PJI. Further study should focus on finding common decolonizing bacterium in patients undertaking elective orthopaedic surgery in China, and further test the appropriateness of using cefuroxime and clindamycin in prophylaxis in primary TJA.…”

Antibiotic resistance in early periprosthetic joint infection

“…Prophylactic antibiotics significantly reduce prosthetic joint infection (PJI) rates after hip and knee arthroplasty . Cefazolin antibiotic prophylaxis is the standard of care in New Zealand; however, the rise of antibiotic resistance in recent decades has raised concerns that cephalosporins may no longer provide adequate prophylaxis …”

“…1 Cefazolin antibiotic prophylaxis is the standard of care in New Zealand; however, the rise of antibiotic resistance in recent decades has raised concerns that cephalosporins may no longer provide adequate prophylaxis. 2,3 In order for prophylactic antibiotics to be effective, their spectrum of activity must cover the organisms likely to cause intraoperative contamination. 4 In total knee arthroplasty (TKA), antibiotics must be effective against the two most common infective organisms: Staphylococcus aureus and coagulase-negative staphylococci (CoNS).…”

Surgical Approaches in Shoulder Arthroplasty

“…If preoperative testing indicates that the patient is colonized with methicillin-resistant Staphylococcus aureus (MRSA), studies show an increased risk of surgical-site infection [11]. In these situations, it is recommended either to decolonize the patient before the surgery or to give a one-time dose of vancomycin [12]. In addition to antibiotics, pre-incision intravenous administration of tranexamic acid has been shown in multiple studies to decrease intraoperative blood loss [13,14].…”