Prophylactic antibiotics in elective hip and knee arthroplasty

Abstract

ObjectivesWe wanted to investigate regional variations in the organisms reported to be causing peri-prosthetic infections and to report on prophylaxis regimens currently in use across England.MethodsAnalysis of data routinely collected by Public Health England’s (PHE) national surgical site infection database on elective primary hip and knee arthroplasty procedures between April 2010 and March 2013 to investigate regional variations in causative organisms. A separate national survey of 145 hospital Trusts (groups of hospitals under local management) in England routinely performing primary hip and/or knee arthroplasty was carried out by standard email questionnaire.ResultsAnalysis of 189 858 elective primary hip and knee arthroplasty procedures and 1116 surgical site infections found statistically significant variations for some causative organism between regions. There was a 100% response rate to the prophylaxis questionnaire that showed substantial variation between individual trust guidelines. A number of regimens currently in use are inconsistent with the best available evidence.ConclusionsThe approach towards antibiotic prophylaxis in elective arthroplasty nationwide reveals substantial variation without clear justification. Only seven causative organisms are responsible for 89% of infections affecting primary hip and knee arthroplasty, which cannot justify such widespread variation between prophylactic antibiotic policies.Cite this article: Bone Joint Res 2015;4:181–189.

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies

“…Compared with one-stage revision patients, the two-stage group had a higher proportion of patients with comorbidities. Staphylococcus species were the most common causative organisms for PJI in both treatment groups, results which are consistent with the literature [ 23 , 29 , 30 ]. In addition, a large percentage of two-stage patients had negative cultures compared with the one-stage group, which reflects evidence that the one-stage is commonly used in patients with known organisms and sensitivities [ 27 ].…”

Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin

“…In England, teicoplanin is the first choice in cases of penicillin allergy—and is even used frequently in other cases as well, which is probably related to the higher prevalence of MRSA in England than in Scandinavia (Hickson et al. 2015 ).…”

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

“…Hickson et al 140 estimated the most common prophylaxis regimes used by NHS trusts for knee and hip replacements. There are three regimes used in the absence of a penicillin allergy: flucloxacillin in combination with gentamicin, cefuroxime alone and teicoplanin in combination with gentamicin.…”