National variation in prophylactic antibiotic use for elective primary total joint replacement

Area of Science:

• Orthopaedic Surgery
• Infectious Diseases
• Pharmacology

Background:

• Prophylactic antibiotic use in elective primary total hip and knee arthroplasty varies significantly across UK hospitals.
• This variation may influence the risk of periprosthetic joint infection (PJI).

Purpose of the Study:

• To identify current antibiotic prophylaxis regimens for elective primary arthroplasty in the UK.
• To analyze variations in these regimens and their potential impact on PJI risk.
• To assess adherence to international consensus guidance for antibiotic prophylaxis.

Main Methods:

• A comprehensive search of hospital and trust websites and the MicroGuide app was conducted to identify prophylactic antibiotic regimens.
• The cost of each regimen was calculated using British National Formulary (BNF) data.
• Regimens were compared against the 2018 Philadelphia Consensus Guidance.

Main Results:

• Wide variations in both primary and alternative prophylactic antibiotic regimens and dosing were observed.
• Some common regimens lack coverage for likely causes of surgical site infection (SSI), such as cefuroxime lacking *Enterococcus* coverage.
• Adherence to the 2018 Philadelphia Consensus Guidance was limited, with a majority of centers not including a cephalosporin.

Conclusions:

• Widespread variation exists in recommended antimicrobial prophylaxis for primary arthroplasty across UK hospitals.
• Current practices may not adequately cover common pathogens, potentially increasing PJI risk.
• There is a clear need for greater standardization and adherence to international guidelines.