Perioperative Antibiotics

Hansen, Erik N.; Belden, Katherine; Silibovsky, Randi; Vogt, Markus; Arnold, William V.; Bićanić, Goran; Bini, Stefano A.; Catani, Fabio; Chen, Jiying; Ghazavi, Mohammad; Godefroy, Karine M.; Holham, Paul; Hosseinzadeh, Hamid Reza Seyyed; Kim, Kang I.I.; Kirketerp‐Møller, Klaus; Lidgren, Lars; Lin, Jian Hao; Lonner, Jess H.; Moore, Christopher C.; Papagelopoulos, Panayiotis J.; Poultsides, Lazaros; Randall, R. Lor; Roslund, Brian; Saleh, Khaled J.; Salmon, Julia V; Schwarz, Edward M.; Stuyck, Jos; Dahl, Annette W; Yamada, Koji

doi:10.1002/jor.22549

Cited by 19 publications

(7 citation statements)

References 222 publications

(241 reference statements)

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“…First or second generation cephalosporins are recommended for routine perioperative surgical prophylaxis with the use of vancomycin or clindamycin as secondary options in patients with a penicillin allergy. Vancomycin should be reserved for patients with known colonization or infection with MRSA [72-74]. …”

Section: The Operation Daymentioning

confidence: 99%

“…In current literature, most of the authors recommend to use within one hour of surgical incision for cephalosporins and can be extended to two hours for vancomycin and fluoroquinolones [74]. In patients with large blood volume loss (>2000 cc) or high volume of fluid resuscitation (>2000cc), and surgery times that last more than two half-lives of the prophylactic agent, an additional intraoperative dose of antibiotics is necessary [78].…”

Section: The Operation Daymentioning

confidence: 99%

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The Prevention of Periprosthetic Joint Infections

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Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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Section: The Operation Daymentioning

confidence: 99%

Section: The Operation Daymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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“…Additionally, 183 of these 510 patients come from a trial that is considered poorly designed from a randomization standpoint [18]. Considering the infection rate in revision THA and TKA is significantly higher than that in primary THA/TKA [7, 8] and; that the consensus recommendation by the Orthopaedic Research Society [12] is that the preoperative antibiotic regimens should be no different between primary and revision THA/TKA - there appears to be no effective prophylaxis regimen(s) that can reduce the infection rate seen in revision THA/TKA. It should be noted that this consensus recommendation has been made using non-randomized studies [12], which thus may render these conclusions questionable.…”

Section: Discussionmentioning

confidence: 99%

“…Further, the infection rates in revision THA/TKA have also more than doubled from 1.4% in the 1991–1994 timeframe to 3.0% in the 2007–2010 timeframe [3]. Despite the statistically significant higher infection rates seen in revision THA/TKA, surprisingly, the current strong consensus is that perioperative antibiotic prophylaxis should be the same for primary and uninfected revision THA/TKA [12]. …”

Section: Introductionmentioning

confidence: 99%

Antibiotics and antiseptics for preventing infection in people receiving revision total hip and knee prostheses: a systematic review of randomized controlled trials

2016

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BackgroundInfection rates in revision (second and subsequent) major joint arthroplasty continues to be a significant issue with rates 2–3 times those of primary procedures. The effect of antibiotic and antiseptic prophylaxis on outcomes for this type of surgery has not been adequately reviewed.MethodsA systematic search of the main databases for randomized controlled trials (RCTs) evaluating antibiotics and antiseptics was conducted to evaluate the predetermined endpoints of infection.ResultsThere were five (5) RCTs identified that examined the effects of antibiotic and antiseptic prophylaxis on infections after revision total hip arthroplasty [THA] (total of 304 participants) and total knee arthroplasty [TKA] (total of 206 participants). For TKA, preoperative systemic intravenous (IV) antibiotic prophylaxis plus antibiotic cement may be effective in reducing the incidence of infection in revision TKA at 8+ years. These results however should be interpreted with caution due to the significant biases. For revision THA, there is no RCT evidence that antibiotics/antiseptics have any effect on the infection rate.ConclusionsThere is a lack of high quality data demonstrating an effect of antibiotics or antiseptics on infection rates in revision THA/TKA. Considering the rate of infections in revisions is 2-3X that of primary procedures and; there is a consensus recommendation to use similar antibiotic and antiseptic regimens in both primary and revision procedures, there is a need for high quality studies in revision THA/TKA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2063-4) contains supplementary material, which is available to authorized users.

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“…Current guidelines advocate a minimum of 2 g cefazolin for patients weighing >70 kg to achieve an effective minimum inhibitory concentration, and an increased weight-adjusted dose of 3 g in patients with an actual body weight >120 kg [25]. However, in patients with a high risk of methicillin-resistant Staphylococcus aureus colonization, such as those institutionalized in nursing homes or dialysis units, dual antibiotic prophylaxis with the additional vancomycin or teicoplanin may be indicated [25,26]. There is also evidence that continuing antibiotic treatment beyond 24 hours is not essential and could lead to increased bacterial resistance [27].…”

mentioning

confidence: 99%