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Prophylactic antibiotics unnecessary in arthroscopic knee meniscectomy

No significant difference in infection rate was found between patients treated with or without prophylactic intravenous antibiotics.

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The routine use of prophylactic intravenous antibiotics does not reduce the risk of deep infection after arthroscopic meniscectomy, a retrospective study suggests.

Jack M. Bert, MD, and colleagues at Summit Orthopedics in St. Paul, Minn., reviewed the incidence of knee joint sepsis among 2,780 patients treated with arthroscopic meniscectomy from July 2000 to July 2003. These patient averaged 43 years of age; 933 patients (34%) received prophylactic antibiotics and 1,847 (66%) did not receive antibiotics.

"Infections were strictly defined as being present in those patients with a positive joint aspirate with clinical signs and symptoms typical of a septic joint," the authors said in the study.

"Only deep infections were included in this study, defined as a positive joint aspirate," they said.

At up to 2 weeks follow-up, the researchers found no significant difference in infection rate between the groups. One patient (0.15%) in the antibiotic group and three patients (0.16%) in the no-antibiotics group developed an infection (P=.59), according to the study.

Investigators identified Staphylococcus aureus as the infecting organism in all four cases, which was coagulase-positive in three cases and coagulase-negative in one.

"All four [patients] responded satisfactorily to a single arthroscopic joint debridement and between 4 and 6 weeks of homebound intravenous antibiotic treatment," the authors said.

They noted that prophylactic antibiotics are routinely used for arthroscopic knee surgeries, although little documented evidence exists supporting such practices.

"Hopefully, further prospective studies will confirm these clinical findings and establish that the standard of care should be avoidance of unnecessary intravenous usage of antibiotics without any evidence of clinical benefit ... to patients undergoing elective arthroscopic surgery," they said.

For more information:

• Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: Is it necessary? Arthroscopy. 2007;23:4-6.