Withholding Preoperative Antibiotic Prophylaxis in Knee Prosthesis Revision: A Retrospective Analysis on Culture Results and Risk of Infection

Wouthuyzen-Bakker, Marjan; Tornero, Eduard; Claret, G; Bosch, Jordi; Martínez-Pastor, Juan C.; Combalía, A.; Soriano, Álex

doi:10.1016/j.arth.2017.03.064

Cited by 30 publications

(18 citation statements)

References 21 publications

(17 reference statements)

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“…Of the nine remaining articles, two were excluded after the full text was read: one study analyzed the culture results after preoperative prophylaxis in primary shoulder arthroplasty (18), and another study analyzed the culture results of prior antimicrobial therapy instead of preoperative antimicrobial prophylaxis (2). Finally, seven studies were considered eligible and included in the final analysis (3,(19)(20)(21)(22)(23)(24). There was 100% agreement between the two reviewers (M. Wouthuyzen-Bakker and N. Benito) for the inclusion of the studies.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 shows the study characteristics of the seven selected studies representing a total of 739 patients. The majority of studies were a Patient characteristics, study design, antibiotic prophylaxis, and diagnostic culture methods of the included studies (3,(19)(20)(21)(22)(23)(24). RCT, randomized controlled trial; PJI, prosthetic joint infection; ND, no data.…”

Section: Resultsmentioning

confidence: 99%

“…It has been shown that when antimicrobial prophylaxis is administered 0 to 60 min after surgical incision, the risk of developing surgical site infections is increased 2-fold, compared to the risk with timely administration (15). Even more importantly, we previously demonstrated in patients who undergo total revision surgery that the PJI rate in the early postoperative period decreased from 6.4% to 1.6% when antimicrobial prophylaxis was no longer postponed until intraoperative tissue cultures were obtained (24). These data suggest that withholding prophylaxis does more harm than good, especially in one-stage revision surgery or in the second stage of a two-stage exchange with a newly placed implant.…”

Section: Discussionmentioning

confidence: 97%

“…b From the data for this cohort, only 24 out of 40 patients with a positive culture before the administration of antimicrobial prophylaxis were analyzed in order to calculate the sensitivity of cultures after antimicrobial prophylaxis. a Summary of the culture yield of patients with a suspected prosthetic joint infection (PJI) prior to surgery who underwent revision surgery with or without preoperative antimicrobial prophylaxis (20,24). b Patients with a (presumed) aseptic loosening or chronic pain who underwent a total, partial, or minor revision surgery.…”

Section: Discussionmentioning

confidence: 99%

“…From the data for this cohort, patients that were treated with debridement or antibiotics and with retention of the prosthesis in this study (14 out of 28) were excluded from the analysis. Available data of included studies (19)(20)(21)(22)24) on the most frequently cultured microorganisms in patients with or without antimicrobial prophylaxis. See Table 1 for the specific details on the study design.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

2017

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Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group ( = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively ( = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

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