Should Preoperative Antibiotics Be Tailored According to Patient's Comorbidities and Susceptibility to Organisms?

Tan, Timothy L.; Gómez, Miguel M.; Kheir, Michael M.; Maltenfort, Mitchell; Chen, Antonia F.

doi:10.1016/j.arth.2016.11.021

Cited by 19 publications

(19 citation statements)

References 25 publications

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Section: Systemic/local Antibioticsmentioning

confidence: 99%

“…Current guidelines for TJA clinical practice most often recommend cefazolin and cefuroxime for patients undergoing TJA, and vancomycin or clindamycin in those with suspected/proven hypersensitivity to the first-line antibiotics [ 139 ]. A universal protocol for antibiotic prophylaxis rather than one tailored for an individual patient should be used in clinical practice [ 140 ]. In revision cases, patients should not receive antimicrobial substances for at least 2 weeks before culture sampling to minimize the chance of false-negative culture results [ 141 ].…”

Section: Perioperative Strategiesmentioning

confidence: 99%

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Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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Section: Systemic/local Antibioticsmentioning

confidence: 99%

Section: Perioperative Strategiesmentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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“…Overall, it is apparent that all these scarce reports with a discrepancy of outcomes do not allow for a generalization of conclusions. The usual perioperative antibiotic prophylaxis involves a first-or second-generation cephalosporin (cefazolin or cefuroxime) regardless of the type of surgery (primary or revision) or comorbidities of the patient [49]. This choice is often appropriate because Gram-positive bacteria are responsible for the majority of PJIs [5].…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Rare Pathogens at the Site of Periprosthetic Hip and Knee Joint Infections: A Retrospective, Single-Center Study

et al. 2021

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The frequency and clinical relevance of rare pathogens at the site of periprosthetic infections of the hip and knee joint and their antibiotic resistance profiles have not yet been assessed in-depth. We retrospectively analyzed all periprosthetic hip and knee joint infections that occurred between 2016 and 2020 in a single center in southwest Germany. Among 165 infections, 9.7% were caused by rare microorganisms such as Veilonella sp., Pasteurella sp., Pantoea sp., Citrobacter koseri, Serratia marcescens, Parvimonas micra, Clostridium difficile, Finegoldia magna, Morganella morganii, and yeasts. No resistance to piperacillin/tazobactam, carbapenemes, fluoroquinolones, or gentamicin was observed. Some bacteria displayed resistance to ampicillin, ampicillin/sulbactam, and cefuroxime. We present follow-up data of patients with infections due to rare pathogens and discuss the importance of close, interdisciplinary collaboration between orthopedic surgeons and clinical microbiologists to carefully select the most appropriate anti-infective treatment regimens for the increasing number of patients with such infections.

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“…The efficacy and value of perioperative antibiotics for surgical prophylaxis has been proven in the literature [8]. Recent studies have supported current universal antibiotic prophylaxis versus providing treatment based on individual comorbidities [9]. [2,14,15,3,16].…”

Section: Discussionmentioning

confidence: 99%

Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection

Rondon

Kheir

Tan

et al. 2018

The Journal of Arthroplasty

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Should Preoperative Antibiotics Be Tailored According to Patient's Comorbidities and Susceptibility to Organisms?

Cited by 19 publications

References 25 publications

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Occurrence of Rare Pathogens at the Site of Periprosthetic Hip and Knee Joint Infections: A Retrospective, Single-Center Study

Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection

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