Antimicrobial Stewardship in Total Joint Arthroplasty: Outcomes of a Collaborative Program Implementation

Area of Science:

• Orthopaedic Surgery
• Infectious Diseases
• Health Services Research

Background:

• Antimicrobial stewardship is vital in orthopaedic surgery, yet data guiding its use in total joint arthroplasty (TJA) is limited.
• There is a need for antimicrobial stewardship program (ASP) implementation and evaluation in TJA care.

Purpose of the Study:

• To assess the impact of an interprofessional ASP on antibiotic selection and patient outcomes in total joint arthroplasty (TJA).

Main Methods:

• A prospective, sequential cohort study evaluated an ASP implemented from late 2017 to December 2019.
• Twelve evidence-based recommendations were implemented, focusing on preoperative antibiotic selection and overall antibiotic exposure.
• Outcomes included optimal antibiotic selection rates, surgical site infection (SSI) and acute kidney injury (AKI) rates, and cost-benefit analysis.

Main Results:

• Optimal preoperative antibiotic selection increased from 64.9% to 95.4% (P < 0.001).
• Second-line and total perioperative antibiotic exposures decreased.
• Total SSI and AKI rates appeared to decrease, with an estimated cost saving of $197,050 per 1000 TJA procedures.

Conclusions:

• A comprehensive ASP for TJA effectively enhanced optimal antibiotic selection and reduced antibiotic exposure.
• The program demonstrated cost savings without negatively impacting SSI or AKI rates.
• This study supports the value of ASPs in optimizing care for TJA patients.