Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Abstract

Background Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. Questions/purposes We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected. Methods We prospectively enrolled and evaluated 40 patients (29 with THAs and 11 with TKAs) who met the following inclusion criteria: older than 18 years, with suspected PJI of unknown cause, undergoing surgical revision. After arthrotomy, three tissue samples were obtained for microbiologic analysis and diagnosis, and antimicrobial prophylaxis (cefazolin 2 g intravenously) then was administered. Later during the procedure, but before débridement and irrigation, the second set of three tissue samples was obtained from the same surgical area and was cultured. Tissue concentration of prophylactic antibiotic was verified with the second set of samples. A positive culture result was defined as one or more positive cultures (growth on agar at or before 14 days). We then compared the yield on the microbiologic cultures obtained before administration of antibiotics with the yield on the cultures obtained after antibiotics were administered. An a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. priori analysis was performed; with the numbers available, we had 98% power to detect a difference in diagnostic sensitivity of 33%. Results With the numbers available, we found no difference in the likelihood that an infection would be diagnosed between the samples obtained before and after administration of antimicrobial prophylaxis...

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

“…Of the nine remaining articles, two were excluded after the full text was read: one study analyzed the culture results after preoperative prophylaxis in primary shoulder arthroplasty (18), and another study analyzed the culture results of prior antimicrobial therapy instead of preoperative antimicrobial prophylaxis (2). Finally, seven studies were considered eligible and included in the final analysis (3,(19)(20)(21)(22)(23)(24). There was 100% agreement between the two reviewers (M. Wouthuyzen-Bakker and N. Benito) for the inclusion of the studies.…”

“…Table 1 shows the study characteristics of the seven selected studies representing a total of 739 patients. The majority of studies were a Patient characteristics, study design, antibiotic prophylaxis, and diagnostic culture methods of the included studies (3,(19)(20)(21)(22)(23)(24). RCT, randomized controlled trial; PJI, prosthetic joint infection; ND, no data.…”

“…In the study of Bedenčič et al (22), in which positive intraoperative tissue cultures were used as a reference test before the administration of antimicrobial prophylaxis, negative cultures were found after prophylaxis in 5 out of 24 patients (21%) for coagulase-negative staphylococci (2 patients), Propionibacterium acnes (2 patients), and Corynebacterium species (1 patient). Unfortunately, in this study, no control group without the administration of antimicrobial prophylaxis was available to determine whether the rate of culture negativity of the second obtained samples at the same surgical area would be different for these microorganisms.…”

Periprostetik enfeksiyonlar: mikrobiyoloji, antibiyotik uygulamaları

“…Protez cerrahisinde, antibiyotik profilaksisi ile bakteri yükü azaltılarak cerrahi yara/alan enfeksiyonu gelişim riski azaltılabilir. [26] 1957 yılından beri yapılan çalışmalar ortopedik cerrahide antibiyotik -kolon segmentlerini de içeren girişimler, -transrektal prostat biyopsisi, -yüksek bakteriyel kolonizasyon riski taşıyan, üriner sisteme girilen her türlü girişim (transüretral kateterizasyon dışında) ve -dental girişimlerdir (tüm diş çekimleri, tüm periodontal girişimler, dental implant girişimleri, kanal tedavilerinin bir kısmı, ortodontik bantların ilk takılması, spesifiye edilmiş lokal anestetik injeksiyonları, kanama olabilecek durumlarda düzenli diş temizliği).…”

“…Yaraya bağlı komplikasyonların sıklığının, cerrahi öncesi 6-8 hafta sigara kullanımının kesilmesi profilaksisinin etkinliğini gösterdiğinden, antibiyotik profilaksisi standart hale gelmiştir. [26] Antibiyotik profilaksisi, enfeksiyon veya kontaminasyon olmadan, dokular bakterilerle karşılaşmadan önce, gelişmesi yüksek olası enfeksiyonların önlen-mesi için yapılan antibiyotik uygulamalarıdır. Cerrahi insizyon sırasında girişim bölgesinde yeterli antibiyotik konsantrasyonu sağlanması, profilaksinin ön koşuludur.…”