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Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures
Daniel Pérez-Prieto1, María E Portillo2, Lluís Puig-Verdié1
1Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
Background:
Culture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures.
Material And Methods:
An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital. Patients were prospectively randomized into two groups. The control group received the classical preoperative antibiotic prophylaxis. The study group did not receive prophylaxis prior to surgery.
Results:
There were 14 patients in each group. They correspond to 13 total hip arthroplasty infections, 12 total knee arthroplasty infections and 3 reverse shoulder prosthesis infections. There were 10 patients in the study group and 10 patients in the control group with at least one positive microbiological criterion (P > 0.05). There were 4 patients in each group with a culture negative PJI (P > 0.05).
Conclusions:
Preoperative antibiotic prophylaxis does not affect intraoperative cultures in suspected or confirmed PJI. Therefore it is essential to deliver antibiotic prophylaxis in any patient in which a prosthesis is to be implanted in order to protect the prosthesis from infection.
Insights
Preoperative antibiotic prophylaxis does not impact intraoperative cultures in prosthetic joint infections (PJI). Antibiotic prophylaxis remains crucial for protecting implants during surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Culture-negative prosthetic joint infections (PJI) present diagnostic challenges.
- Some surgeons hesitate to use preoperative antibiotic prophylaxis for suspected PJI.
- Evaluating the effect of prophylaxis on intraoperative cultures is critical.
Purpose of the Study:
- To determine if preoperative antibiotic prophylaxis influences intraoperative culture results in patients with suspected or confirmed PJI.
Main Methods:
- Prospective randomized study using the Zimmerli criteria for PJI diagnosis.
- Two groups: control (received prophylaxis) and study (no prophylaxis).
- Included patients with hip, knee, and shoulder prosthesis infections.
Main Results:
- 14 patients per group; 28 total patients analyzed.
- No significant difference in positive microbiological criteria between groups (10 vs. 10).
- Similar rates of culture-negative PJI in both groups (4 vs. 4).
Conclusions:
- Preoperative antibiotic prophylaxis does not alter intraoperative culture findings in PJI.
- Antibiotic prophylaxis is essential for preventing prosthesis infection during implantation.
- Continued use of prophylaxis is recommended for all prosthetic surgeries.
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