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Extended oral antibiotics in high-risk patients may significantly reduce infection rate after TKA, THA
According to recently published results, extended postoperative antibiotic prophylaxis was linked to a statistically significant and clinically meaningful decrease in the 90-day infection rate for patients who were at high risk of infection following a total knee or total hip arthroplasty.
“We were encouraged by the statistically significant and clinically meaningful four-fold decrease in 90-day postoperative infection rates in high-risk patients, confirming our clinical and experienced-based hypothesis,” Michael R. Meneghini, MD, told Healio.com/Orthopedics. “Providing patients who are at high-risk for periprosthetic joint infection (PJI) after hip or knee arthroplasty with a week of oral prophylactic antibiotics can result in a clinically meaningful reduction in postoperative PJI. Prevention of even a single devastating case of PJI can alleviate suffering for patients and their families, as well as save the health care system millions on a larger scale.”
Researchers performed a retrospective cohort study and identified 2,181 primary TKAs and THAs performed at a suburban academic hospital with modern perioperative and infection-prevention protocols between 2011 and 2016. Extended oral antibiotic prophylaxis for 7 days after discharge was implemented in January 2015 for patients at high risk for PJI. Investigators identified the percentages of patients who were diagnosed with PJI and then compared between the groups of patients that did vs. did not receive extended oral antibiotic prophylaxis.
Results showed the infection rate after TKA was 1% and was 2.2% after THA. Investigators noted patients without extended antibiotic prophylaxis who underwent TKA and were at high-risk of infection had a 4.9-times greater chance of PJI and patients who underwent THA without extended antibiotic prophylaxis had a four-times greater chance compared with high-risk patients with extended antibiotic prophylaxis.
"The most commonly anticipated hesitation before implementing this protocol into practice is fears of contributing to antimicrobial resistance (AMR). However, studies have demonstrated that surgical prophylaxis actually contributes minimally to AMR compared to antibiotics prescribed in the ambulatory and acute-care medical setting,” Meneghini said. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.