Article

Antibiotic prophylaxis for wound infections in total joint arthroplasty. A Systemic Review

Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
The Bone & Joint Journal (Impact Factor: 2.8). 07/2008; 90(7):915-9. DOI: 10.1302/0301-620X.90B7.20498
Source: PubMed

ABSTRACT We reviewed systematically the published evidence on the effectiveness of antibiotic prophylaxis for the reduction of wound infection in patients undergoing total hip and total knee replacement. Publications were identified using the Cochrane Library, MEDLINE, EMBASE and CINAHL databases. We also contacted authors to identify unpublished trials. We included randomised controlled trials which compared any prophylaxis with none, the administration of systemic antibiotics with that of those in cement, cephalosporins with glycopeptides, cephalosporins with penicillin-derivatives, and second-generation with first-generation cephalosporins. A total of 26 studies (11 343 participants) met the inclusion criteria. Methodological quality was variable. In a meta-analysis of seven studies (3065 participants) antibiotic prophylaxis reduced the absolute risk of wound infection by 8% and the relative risk by 81% compared with no prophylaxis (p < 0.00001). No other comparison showed a significant difference in clinical effect. Antibiotic prophylaxis should be routine in joint replacement but the choice of agent should be made on the basis of cost and local availability.

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    • "There is no evidence to suggest that new-generation cephalosporins or the administrations of antibiotics beyond 24 hours postoperatively are more effective at preventing postoperative PJI in THA/TKA surgery than first-generation cephalosporins or single-dose or short-term administration . The use of one-dose first-generation cephalosporin is effective enough, reducing costs, risk of toxicity, and the development of bacterial resistance [12] [14]. "
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    ABSTRACT: This review summarizes the existing economic literature, assesses the value of current data, and presents procedures that are the less costly and more effective options for the treatment of periprosthetic infections of knee and hip. Optimizing antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room, the detection and treatment of high-risk patient groups, as well as the rational management of the existing infection by using the different procedures according to each particular case, could allow for improved outcomes and lead to the highest quality of life for patients and the lowest economic impact. Nevertheless, the costeffectiveness of different interventions to treat periprosthetic infections remains unclear.
    The Scientific World Journal 05/2013; 2013:821650. DOI:10.1155/2013/821650 · 1.73 Impact Factor
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    • "The types of patients undergoing THA/TKA are consistent and the risks of surgery are well characterized. Antibiotic prophylaxis for THA/TKA is estimated to decrease the relative risk of wound infection by 81% compared with no prophylaxis [2]. Similarly, the appropriate use of anticoagulant drugs has been shown to reduce the risk of venous thromboembolism (VTE) after THA/TKA, and guidelines recommend their routine use after this type of surgery. "
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    ABSTRACT: Anticoagulant drugs reduce the risk of venous thromboembolic events after total hip and knee arthroplasty. However, the use of current drugs, such as low molecular weight heparins, is hampered by their subcutaneous route of administration. The use of vitamin K antagonists is hampered by the requirement for routine coagulation monitoring and dose titration to provide effective anticoagulation without an increased risk of bleeding and numerous food and drug interactions. Clearly, there is a need for new oral, fixed-dose anticoagulant drugs that do not require coagulation monitoring, while demonstrating similar or better efficacy and safety profiles when compared with current agents.
    07/2010; 2010:280731. DOI:10.1155/2010/280731
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    • "Antibiotic prophylaxis is important to minimize the risk of infection, and the evidence for its use has been growing. A recent systematic review (AlBuhairan et al. 2008) of the effectiveness of antibiotic prophylaxis in patients undergoing total hip and knee replacement found that antibiotic prophylaxis reduced the absolute risk of wound infection by 81% compared with no prophylaxis (p < 0.001) (pooled analysis of 7 studies; n = 3,065). Furthermore, a study from the Norwegian "
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    ABSTRACT: There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working. In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records. 45% (95% CI: 36-54) of the patients operated in Lund and 57% (CI: 50-64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15-45 min before the start of surgery. 53% (CI: 46-61) received antibiotics 15-45 min before inflation of a tourniquet. The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.
    Acta Orthopaedica 12/2009; 80(6):633-8. DOI:10.3109/17453670903316868 · 2.45 Impact Factor
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