Antibiotic Prophylaxis to Prevent Infection in Total Knee Arthroplasty

2017 ◽  
pp. 35-46
Author(s):  
Alfonso Vaquero-Picado ◽  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Total Knee

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

2019 ◽  
Vol 33 (02) ◽  
pp. 100-105 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Aldo M. Riesgo ◽  
Preetesh D. Patel ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Postoperative Infection ◽  
Prophylactic Antibiotic ◽  
The United States ◽  
Prophylactic Antibiotics ◽  
Infection Rates ◽  
Mrsa Infection ◽  
Total Knee

AbstractThe risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

Antibiotic Prophylaxis and Tourniquet Inflation in Total Knee Arthroplasty

1990 ◽  
Vol 260 ◽  
pp. 17-23 ◽  
Author(s):  
Richard J. Friedman ◽  
Lawrence V. Friedrich ◽  
Roger L. White ◽  
Michael B. Kays ◽  
Dianne M. Brundage ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Total Knee ◽  
Tourniquet Inflation

scholarly journals Intraosseous Regional Administration of Antibiotic Prophylaxis in Total Knee Arthroplasty

2020 ◽  
Vol 10 (4) ◽  
pp. e20.00001
Author(s):  
Jaymeson R. Arthur ◽  
Joshua S. Bingham ◽  
Henry D. Clarke ◽  
Mark J. Spangehl ◽  
Simon W. Young
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Regional Administration ◽  
Total Knee

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty—No Benefit for Extremely Obese Patients

2021 ◽  
Author(s):  
Mark K. Lane ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Obese Patients ◽  
Exact Test ◽  
Primary Tkas ◽  
Risk Patients ◽  
Total Knee

AbstractWe performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including “on-time” dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's t-test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with “on time” vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, p < 0.01). “On Time” vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI < 45 kg/m2 (0.5 vs. 2.6%, p < 0.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9 kg/m2 (p < 0.01). No difference was noted for patients with a BMI ≥ 45 kg/m2 (3.3 vs. 2.6%, p = 0.71). There were no infections in 150 TKA patients with a normal BMI (18–25 kg/m2) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18–25 kg/m2) or for higher risk patients with a BMI > 45 kg/m2.

scholarly journals Cost-effectiveness of dental antibiotic prophylaxis in total knee arthroplasty recipients with type II diabetes mellitus

2020 ◽  
Vol 2 (4) ◽  
pp. 100084
Author(s):  
Elizabeth E. Stanley ◽  
Taylor P. Trentadue ◽  
Karen C. Smith ◽  
James K. Sullivan ◽  
Thomas S. Thornhill ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Total Knee Arthroplasty ◽  
Cost Effectiveness ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Type Ii Diabetes ◽  
Type Ii Diabetes Mellitus ◽  
Type Ii ◽  
Total Knee

scholarly journals Timing of Antibiotic Prophylaxis for Primary Total Knee Arthroplasty Performed during Ischemia

2008 ◽  
Vol 46 (7) ◽  
pp. 1009-1014 ◽  
Author(s):  
Alex Soriano ◽  
Guillem Bori ◽  
Sebastián García‐Ramiro ◽  
Juan C. Martinez‐Pastor ◽  
Teresa Miana ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals 815. Short-Course vs. Extended-Course Perioperative Antibiotic Prophylaxis in Patients Receiving Unilateral Primary Total Knee Arthroplasty

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S500-S501
Author(s):  
Jia Le Lim ◽  
Daphne Yah Chieh Yii ◽  
Kai Chee Hung ◽  
Winnie Lee ◽  
Lay Hoon Andrea Kwa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Diabetic Patients ◽  
Short Course ◽  
Total Knee ◽  
Extended Course ◽  
Primary Total Knee

Abstract Background International guidelines recommend up to 24 hours of perioperative antibiotic prophylaxis (AP) in joint replacement procedures. However, some observational studies support AP beyond 24 hours for the prevention of surgical site infections (SSI) and prosthetic joint infections (PJI), and this practice is also observed in our institution. This study aims to evaluate the incidence of SSI and PJI in patients receiving short- vs extended-course AP after unilateral primary total knee arthroplasty (TKA) at our center. Methods This was a retrospective cohort study of patients who underwent elective unilateral primary TKA from October to December 2019 at Singapore General Hospital. Patients were excluded if they received antibiotics for reasons other than post-operative AP or underwent other procedures in addition to unilateral primary TKA. Data was collected from electronic medical records and patients who received a short-course of AP (≤24 hours) were compared with patients who received an extended-course of AP. Primary outcomes were 30-day SSI and 30-day PJI rates. Secondary outcome was the impact of duration of AP on length of stay. Statistical analysis was performed using SPSS software version 20. Results There were 394 patients included in the study. 247 received short-course and 147 received extended-course AP. There were no differences in demographics (Table 1). Amongst those who received extended-course AP, median duration was 7 (IQR 4, 8) days, during which 119 (81.0%) patients switched from intravenous to oral route of antibiotics. Between the short- and extended-course arms, there were no differences observed in 30-day SSI (6.9% vs 6.1%, p=0.769) or PJI rates (0.4% vs 0.7%, p=0.999). However, extended-course AP was associated with a longer median length of stay (4 [IQR 3, 6] vs 5 [IQR 4, 7] days, p=0.001). In a subgroup analysis of 106 diabetic patients, there were no differences in 30-day SSI rates (12.3% vs 9.8%, p=0.763) and 30-day PJI rates (0% vs 2.4%, p=0.387) between both groups. Conclusion In this single center study, short-course AP in elective TKA was safe and effective. Extending AP did not reduce SSI or PJI rates, even in diabetic patients. In addition, extending AP was associated with increased length of stay, which translates to higher healthcare costs. Disclosures All Authors: No reported disclosures

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