Extended Oral Antibiotic Prophylaxis in Primary Hip Arthroplasty: Does it Decrease Periprosthetic Joint Infections?
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Published:
Oct 17, 2023
Keywords:
Periprosthetic joint infections, primary hip arthroplasty, extended oral antibiotic prophylaxis, standard oral antibiotic prophylaxis
Main Article Content
Abstract
Introduction: The prevalence of periprosthetic infections (PPIs) after primary total hip arthroplasty (THA) is approximately 2%. The objective of this study is to determine if there are statistically significant differences between the proportion of acute PPIs with extended oral antibiotic prophylaxis (7 days) vs standard oral antibiotic prophylaxis (24 hours).
Materials and Methods: A prospective clinical trial was conducted between July 2021 and May 2022. A total of 28 adult patients with hip fracture underwent a primary arthroplasty and received extended oral antibiotic (EOA) prophylaxis for 7 days with first-generation cephalosporins. They were compared to a secondary database of the hospital registry, which included a total of 95 adult patients with hip fractures who underwent primary arthroplasty and received a standard oral antibiotic (SOA) prophylaxis for 24 hs.
Results: In the EOA group, the rate of acute PPI was 10.71%, while in the SOA group it was 17.89%. When comparing the rate in both groups, no statistically significant differences were found (p=0.36).
Conclusions: Although the available literature suggests that extended antibiotic prophylaxis can be a simple, safe, and cost-effective measure to counteract the patient’s non-modifiable factors and thus reduce periprosthetic infections, our study found no evidence that it reduces the proportion of acute PPI at 30 days in primary hip arthroplasties.
Materials and Methods: A prospective clinical trial was conducted between July 2021 and May 2022. A total of 28 adult patients with hip fracture underwent a primary arthroplasty and received extended oral antibiotic (EOA) prophylaxis for 7 days with first-generation cephalosporins. They were compared to a secondary database of the hospital registry, which included a total of 95 adult patients with hip fractures who underwent primary arthroplasty and received a standard oral antibiotic (SOA) prophylaxis for 24 hs.
Results: In the EOA group, the rate of acute PPI was 10.71%, while in the SOA group it was 17.89%. When comparing the rate in both groups, no statistically significant differences were found (p=0.36).
Conclusions: Although the available literature suggests that extended antibiotic prophylaxis can be a simple, safe, and cost-effective measure to counteract the patient’s non-modifiable factors and thus reduce periprosthetic infections, our study found no evidence that it reduces the proportion of acute PPI at 30 days in primary hip arthroplasties.
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How to Cite
Zalba, J., Donnari, E., Poza Román, D. D., Paschetta Arrue, A. M., Pirola, J. M., Alvez, E. C., Di Fazio Sale, J. P., Tellarini, B., & Pesci, J. P. (2023). Extended Oral Antibiotic Prophylaxis in Primary Hip Arthroplasty: Does it Decrease Periprosthetic Joint Infections?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 527-538. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1756
Section
Clinical Research
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References
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Arthroplasty 2021;36(7S):S18-S25. https://doi.org/10.1016/j.arth.2021.01.051
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3. Shohat N, Bauer T, Buttaro M, Budhiparama N, Cashman J, Della Valle CJ, et al. Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints? Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019;34(2):S325-S327. https://doi.org/10.1016/j.arth.2018.09.045
4. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et. Al. Epidemiología de la
fractura de cadera en la Argentina. Rev Asoc Argent Ortop Traumatol 2020;85(4):437-46.
https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
5. Aboltins C, Berdal J, Casas F, Corona PS, Cuellar D, Ferrari MC, et al. Hip and knee section, prevention,
antimicrobials (systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty
2019;34(2S):S279-S288. https://doi.org/10.1016/j.arth.2018.09.012
6. Yates A. Postoperative prophylactic antibiotics in total joint arthroplasty. Arthroplast Today 2018;4(1):130-1.
https://doi.org/10.1016/j.artd.2018.01.003
7. Hong C, Black C, Ryan S, Seyler TM. Extended oral antibiotics and infection prophylaxis after a primary or
revision total knee arthroplasty. J Knee Surg 2020;33(2):111-8. https://doi.org/10.1055/s-0039-3400755
8. Siddiqi A, Forte S, Docter S, Bryant D, Sheth NP, Chen AF. Perioperative antibiotic prophylaxis in total joint
arthroplasty: A systematic review and meta-analysis. J Bone J Surg Am 2019;101(9):828-42.
https://doi.org/10.2106/JBJS.18.00990
9. Branch-Elliman W, O’Brien W, Strymish J, Itani K, Wyatt C, Gupta K. Association of duration and type of surgical
prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019;154(7):590-8.
https://doi.org/10.1001/jamasurg.2019.0569
10. Bukowski BR, Owen AR, Turner TW, Fruth KM, Osmon DR, Pagnano MW, et al. Extended oral antibiotic
prophylaxis after aseptic revision total hip arthroplasty: does it decrease infection risk? J Arthroplasty
2022;37(12):2460-5. https://doi.org/10.1016/j.arth.2022.06.023
11. Inabathula A, Dilley JE, Ziemba-Davis M, Warth LC, Azzam KA, Ireland PH, et al. Extended oral antibiotic
prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am 2018;100(24):2103-9. https://doi.org/10.2106/JBJS.17.01485
oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up. J
Arthroplasty 2021;36(7S):S18-S25. https://doi.org/10.1016/j.arth.2021.01.051
2. Valencia J, Orani J, Fernandez L. Infección del sitio quirúrgico - Análisis de los factores de riesgo en los servicios
de ortopedia y traumatología. PROATO, Programa de Actualización en Ortopedia y Traumatología. Vigésimo primer ciclo, Módulo 3, 2021.
3. Shohat N, Bauer T, Buttaro M, Budhiparama N, Cashman J, Della Valle CJ, et al. Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints? Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019;34(2):S325-S327. https://doi.org/10.1016/j.arth.2018.09.045
4. Garabano G, Cubecino A, Simesen de Bielke H, Robador N, Olivetto JM, Sierto M, et. Al. Epidemiología de la
fractura de cadera en la Argentina. Rev Asoc Argent Ortop Traumatol 2020;85(4):437-46.
https://doi.org/10.15417/issn.1852-7434.2020.85.4.1113
5. Aboltins C, Berdal J, Casas F, Corona PS, Cuellar D, Ferrari MC, et al. Hip and knee section, prevention,
antimicrobials (systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty
2019;34(2S):S279-S288. https://doi.org/10.1016/j.arth.2018.09.012
6. Yates A. Postoperative prophylactic antibiotics in total joint arthroplasty. Arthroplast Today 2018;4(1):130-1.
https://doi.org/10.1016/j.artd.2018.01.003
7. Hong C, Black C, Ryan S, Seyler TM. Extended oral antibiotics and infection prophylaxis after a primary or
revision total knee arthroplasty. J Knee Surg 2020;33(2):111-8. https://doi.org/10.1055/s-0039-3400755
8. Siddiqi A, Forte S, Docter S, Bryant D, Sheth NP, Chen AF. Perioperative antibiotic prophylaxis in total joint
arthroplasty: A systematic review and meta-analysis. J Bone J Surg Am 2019;101(9):828-42.
https://doi.org/10.2106/JBJS.18.00990
9. Branch-Elliman W, O’Brien W, Strymish J, Itani K, Wyatt C, Gupta K. Association of duration and type of surgical
prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019;154(7):590-8.
https://doi.org/10.1001/jamasurg.2019.0569
10. Bukowski BR, Owen AR, Turner TW, Fruth KM, Osmon DR, Pagnano MW, et al. Extended oral antibiotic
prophylaxis after aseptic revision total hip arthroplasty: does it decrease infection risk? J Arthroplasty
2022;37(12):2460-5. https://doi.org/10.1016/j.arth.2022.06.023
11. Inabathula A, Dilley JE, Ziemba-Davis M, Warth LC, Azzam KA, Ireland PH, et al. Extended oral antibiotic
prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am 2018;100(24):2103-9. https://doi.org/10.2106/JBJS.17.01485