Antibiotic prophylaxis in orthopedic prosthetic surgery

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Pharmacology

Background:

• Staphylococci, particularly Staphylococcus epidermidis, are the primary cause of orthopedic prosthetic surgery infections.
• Cefazolin, cefamandole, and cefuroxime are standard prophylactic antibiotics due to their efficacy against common staphylococci.
• Increasing resistance to methicillin necessitates alternative prophylactic strategies, including glycopeptides like vancomycin and teicoplanin, especially in high-resistance environments.

Purpose of the Study:

• To evaluate the efficacy and safety of regional teicoplanin prophylaxis in total primary knee replacement (TKR) surgery.
• To compare the effectiveness of regional teicoplanin prophylaxis with conventional systemic prophylaxis in preventing postoperative infections.

Main Methods:

• A prospective, controlled, open study was conducted on patients undergoing primary TKR.
• Regional prophylaxis involved injecting teicoplanin into a foot vein after tourniquet inflation to occlude systemic circulation.
• Conventional prophylaxis involved systemic injection of antibiotics before tourniquet application.

Main Results:

• Regional teicoplanin prophylaxis achieved higher teicoplanin concentrations in the operative field compared to systemic prophylaxis.
• The rate of postoperative infection with regional teicoplanin prophylaxis was similar to that of conventional prophylactic regimens.
• Regional prophylaxis was demonstrated to be a safe and valuable technique for TKR.

Conclusions:

• Regional teicoplanin prophylaxis is a safe and effective method for preventing infections in total knee replacement surgery.
• This technique provides superior antibiotic concentrations at the surgical site compared to traditional systemic administration.
• Regional prophylaxis offers comparable infection rates to conventional methods, representing a valuable alternative, particularly in the context of rising antibiotic resistance.