Preoperative Prophylactic Antibiotics in Total Hip and Knee Arthroplasty: What, When, and How

Spangehl, Mark J.

doi:10.1016/j.arth.2022.01.019

Cited by 11 publications

(5 citation statements)

References 31 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the fact that some studies have found that subsequent use of post-operative antibiotics after the initial preoperative dose may not give additional benefit. [1,10,11,14,15,19] However, some other studies have noted that post-operative doses after the initial pre-operative dose have an advantage over preoperative-only doses. [ 3,35,38] So, if we ignore confounding factors like the expertise of the operating surgeon, the operating time, and patient comorbidities, what made the difference between the prevalence of 0.77% of SSIs in our centre and that of other similar centres operating under almost the same conditions?…”

Section: Discussionmentioning

confidence: 99%

“…This deliberate modulation mitigates the risk of adverse reactions, notably histamine release, which can precipitate hypotension and the potentially severe red man syndrome. [2,10] Further complexity emerges upon consideration of the differential tissue penetration rates characterizing various antibiotics. While certain agents, such as cefazolin, demonstrate rapid infiltration into bone, synovium, and soft tissue, others traverse a more protracted trajectory.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

A.C Nwachukwu

2024

Int. J. Sci. Res. Arch.

View full text Add to dashboard Cite

Introduction: Total knee arthroplasty periprosthetic joint infection (PJI) poses a significant challenge in orthopaedic surgery, often resulting in early failure and associated with high morbidity and mortality rates. Various treatment strategies exist, including debridement, antibiotic therapy, and prosthesis retention, with preventive measures such as antibiotic-impregnated cement and prophylactic antibiotics administration recommended by the American Academy of Orthopaedic Surgeons (AAOS). Methodology: This prospective cohort study was conducted in an orthopaedic hospital in Awka, Southeast Nigeria, spanning seven years (2014-2021). A total of 134 patients who underwent primary and revision knee arthroplasty were included. The hospital's antibiotic prophylaxis protocol for implant surgeries, including arthroplasties, involved a triple combination of ceftriaxone, ciprofloxacin, and metronidazole administered pre-, intra-, and postoperatively for a minimum of 7 days. Results: The study population had a mean age of 63.6 years, predominantly female (77.7%), and of Christian faith (100%). Most participants were of Igbo ethnicity (99.3%), married (90.7%), and engaged in business (37.7%). Severe osteoarthritis was the primary diagnosis in 97.0% of cases, while rheumatoid arthritis accounted for 3.0%. The triple antibiotic prophylaxis regimen resulted in only one case of superficial infection, with no instances of deep infection recorded. Conclusion: Triple antibiotics prophylaxis, comprising ceftriaxone, ciprofloxacin, and metronidazole, demonstrated effectiveness in preventing infections associated with total knee arthroplasty. This regimen maintained surgical site infection prevalence within acceptable limits for clean surgeries, without observable antibiotic resistance in the study population.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

A.C Nwachukwu

2024

Int. J. Sci. Res. Arch.

View full text Add to dashboard Cite

show abstract

“…Most of them focused on the effect of penicillin allergy in patients undergoing orthopedic surgery. 5,[9][10][11][12][13][14][15] Some others examined this in patients undergoing colorectal and abdominal surgery, 9,16,17 cardiac interventions, 9 oral surgery, 18 or gynecologic surgery. 9 However, to the best of our knowledge, there is no study that has investigated the impact of a reported penicillin allergy in patients who have undergone cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Grossmann,

Kersting,

Affentranger

et al. 2023

ASHE

View full text Add to dashboard Cite

Objective: Up to 10% of patients report penicillin allergy (PA), although only 1% are truly affected by Ig-E-mediated allergies. PA has been associated with worse postoperative outcomes, but studies on the impact of reported PA in cancer patients are lacking, and especially in these multimorbid patients, a non-complicated course is of utmost importance. Methods: Retrospective analysis of patients undergoing elective oncological surgery at a tertiary reference center. Data on surgical site infections (SSI), postoperative complications (measured by Clavien-Dindo classification and Comprehensive Complication Index (CCI)), hospitalization duration, and treatment costs were collected. Results: Between 09/2019 and 03/2020, 152 patients were identified. 16/152 patients (11%) reported PA, while 136/152 (89%) did not. There were no differences in age, BMI, Charlson Comorbidity Index, and smoking status between groups (p > 0.4). Perioperative beta-lactam antibiotics were used in 122 (89.7%) and 15 (93.8%) patients without and with reported PA, respectively. SSI and mean numbers of infections occurred non-significantly more often in patients with PA (p = 0.2 and p = 0.47). The median CCI was significantly higher in PA group (26 vs. 51; p = 0.035). The median hospitalization duration and treatment costs were similar between non-PA and PA groups (4 vs 3 days, p = 0.8; 16’818 vs 17’444 CHF, p = 0.4). Conclusions: In patients undergoing cancer surgery, reported PA is common. Failure to question the unproven PA may impair perioperative outcomes. For this reason, patient and provider education on which reactions constitute a true allergy would also assist in allergy de-labeling. In addition, skin testing and oral antibiotic challenges can be performed to identify the safe antibiotics and to de-label appropriate patients.

show abstract

“…The audit was conducted against our local guidelines on antibiotic prophylaxis in orthopedic surgery and international best practices [ 10 ]. The prophylactic antibiotic regimen in our hospital is weight-based intravenous flucloxacillin and gentamicin administered within one hour prior to incision or knife to skin (KTS), and three subsequent doses of intravenous flucloxacillin at six hours, 12 hours, and 18 hours postoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…The understanding that the initial two hours following an incision are critical for the potential introduction of pathogens emphasizes the importance of promptly administering prophylactic antibiotics. Typically, these antibiotics should be given within 60 minutes before the surgical incision [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Antibiotics Prophylaxis Practice in Arthroplasty Surgeries

Oladeji,

Wusu,

Lashin

et al. 2024

Cureus

View full text Add to dashboard Cite

Background Infection in orthopedic surgery is one of the most dreaded complications. It is associated with prolonged morbidity, disability, and increased mortality. One of the cornerstones of the prevention of infections is antibiotic prophylaxis. This study assessed the practice of antibiotic prophylaxis in arthroplasty surgeries in our local hospital. Methods One hundred and seventy-one elective joint replacement patients were retrospectively analyzed for documentation of antibiotic plan in postoperative instruction, choice of antibiotic, dose, and dosage. Compliance with the dosage (duration and frequency) of antibiotic prophylaxis was compared among patients who underwent different operations, among patients whose operation notes had antibiotics plans, and among those patients whose operation notes lacked this information. Results Ninety-six females and 75 males with a mean age of 71.4±9.8 years who underwent hip replacement, knee replacement, or shoulder replacement were included in this study. Preoperative and postoperative antibiotics were received by 100% and 94.7% of patients, respectively. In 19.3%, there was no instruction about postoperative antibiotics while 4% missed at least one postoperative dose. The dosage of postoperative prophylactic antibiotics was variable as 26.3% of the patients experienced delayed administration of doses. Not having intravenous access, failure to prescribe antibiotics, and prescribing antibiotics in the "once only" rather than "regular medication" section of the medication chart were the reasons for improper timing of antibiotic doses. Observing surgical safety checklist was effective in ensuring preoperative antibiotic administration, whereas failing to document antibiotic plan in operation note was associated with poor compliance with postoperative dosage. Interprofessional participation is crucial to compliance with antibiotic prophylaxis practice. Conclusion This study identified key areas for improvement in our antibiotics prophylaxis practice. It resulted in implementing strategies to improve staff's awareness about the importance of timely administration of prophylactic antibiotics and proper documentation by all team members.

show abstract

Preoperative Prophylactic Antibiotics in Total Hip and Knee Arthroplasty: What, When, and How

Cited by 11 publications

References 31 publications

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

Prevalence of reported penicillin allergy and associations with perioperative complications, length of stay, and cost in patients undergoing elective cancer surgery

Antibiotics Prophylaxis Practice in Arthroplasty Surgeries

Contact Info

Product

Resources

About