Prophylactic Antibiotics in Hip and Knee Arthroplasty

Abstract

Prophylactic parenteral antibiotics have contributed to the present low rate of surgical site infections following hip and knee arthroplasty. Over the past decade, there has been a change in the pattern of methicillin-resistant Staphylococcus aureus infections from hospital-acquired to community-acquired. The findings of recent studies on screening programs to identify carriers of methicillin-resistant Staphylococcus aureus have been equivocal, with some studies showing that such programs reduce the rate of infections and others showing no effect on infection rates. Hospitals with antibiogram data that reveal high Staphylococcus resistance should consider use of vancomycin as a prophylactic antibiotic.

Prevention of Periprosthetic Joint Infection

“…It is believed that prophylactic antibiotics are one of the most important factors in preventing PJI (40)(41)(42)(43). One of the sentinel studies in the field of orthopaedic surgery is that of Fogelberg et al, in 1970 (40).…”

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

“…Despite improvements in intraoperative techniques to enhance the sterility of the procedure and the ability of preoperative prophylactic antibiotics to reduce infection rates, longer and more rigorous followup of patients has reported deep site infections at a frequency of 0.25% to 2%, depending on surveillance periods [16]. Diagnosis has typically been made using a combination of history, physical exam, and laboratory investigations, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.…”

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Three)

“…These included all 3 MRSA infections, all 3 Pseudomonas aeruginosa infections, and 11 coagulase-negative Staphylococcus infections (11,12). Wiesel and Esterhai (13) recommend administration of vancomycin in institutions where the prevalence of MRSA is greater than 10% to 20%.…”