[Antibiotic chemoprophylaxis in orthopedic prosthesis implantation]

In elective orthopedic surgery, as well as in any type of clean operations, it is now advised to administer antibiotic prophylaxis only when extraneous material is implanted (prostheses). Given the most frequent appearance of staphylococcal postoperative infections, in orthopedic surgery the antibiotic used for prophylaxis should be particularly active against these microorganisms. Therefore, the first- (cefazolin) and second-generation (cefuroxime or cefamandole) cephalosporins are usually recommended. Because prosthetic infections are more and more frequently caused by methicillin-resistant staphylococci, the glycopeptides (vancomycin and teicoplanin) are often recommended for prophylaxis and more frequently used in routine practice, at least in hospital environments in which these microorganisms often appear. Indeed, various investigations have demonstrated that a single dose of teicoplanin is equally protective as multiple doses of other antibiotics usually used. Regardless of the type of surgery, perioperative prophylaxis should be administered as an i.v. bolus or as a small infusion. However, for mono- or bilateral knee prosthesis, regional prophylaxis has been suggested in recent years, i.e., antibiotic administration in a vein of the foot or leg being operated. The pharmacokinetic and clinical results of this technique have proved to be quite successful.