Prophylactic Antibiotics
We suggest that prophylactic preoperative antibiotics not be withheld in patients at lower probability for periprosthetic joint infection and those with an established diagnosis of periprosthetic joint infection who are undergoing reoperation.
MODERATE RECOMMENDATION Rationale
Two Level II studies and two joint registry studies found that the administration of perioperative antibiotics significantly decreased the risk of postoperative infection.14, 26, 28, 43 These studies however, do not address whether or not the administration of preoperative antibiotics interfere with intraoperative cultures. One Level III study did not find a significant difference in the false negative rate of intraoperative knee cultures in patients receiving perioperative antibiotic prophylaxis (12.5 vs. 8.1%; p=0.34).34
Patients who contract periprosthetic infection face catastrophic complications including additional surgery, increased cost and prolonged treatment, as well as possible permanent loss of the prosthesis. The important role of antibiotic prophylaxis in helping to prevent these catastrophic events outweighs the potential risks.
Patients who contract periprosthetic infection face catastrophic complications including additional surgery, increased cost and prolonged treatment, as well as possible permanent loss of the prosthesis. The important role of antibiotic prophylaxis in helping to prevent these catastrophic events outweighs the potential risks.
- (14) Carlsson AK, Lidgren L, Lindberg L. Prophylactic antibiotics against early and late deep infections after total hip replacements. Acta Orthop Scand 1977;48(4):405-410.
- (26) Doyon F, Evrard J, Mazas F, Hill C. Long-term results of prophylactic cefazolin versus placebo in total hip replacement. Lancet 1987;1(8537):860.
- (28) Engesaeter LB, Lie SA, Espehaug B, Furnes O, Vollset SE, Havelin LI. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 2003;74(6):644-651.
- (34) Ghanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF, Barrack R. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res 2007;461:44-47.
- (43) Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 2009;91(1):38-47.