Antibiotic prophylaxis prior to colonoscopy with biopsy does not decrease risk of prosthetic joint infection in total...

Area of Science:

• Orthopedic Surgery
• Gastroenterology
• Infectious Diseases

Background:

• Prosthetic joint infection (PJI) poses significant risks and costs.
• The potential link between invasive colonoscopies and PJI is under investigation.
• Clinical guidance on antibiotic prophylaxis for colonoscopies in PJI patients is lacking.

Purpose of the Study:

• To compare PJI rates in patients undergoing colonoscopies with and without antibiotic prophylaxis.
• To analyze PJI occurrences at 90 days, 6 months, 9 months, and 1 year post-procedure.
• To assess the impact of antibiotic prophylaxis on PJI rates to inform clinical guidelines.

Main Methods:

• A national, all-payer database was queried for 1.9 million primary total knee arthroplasty procedures (Jan 2010-Oct 2020).
• Patients with prior PJI or PJI within one year of the index procedure were excluded.
• Three cohorts were identified: colonoscopy with biopsy without prophylaxis, colonoscopy with biopsy with prophylaxis, and a control group (no prior colonoscopy).

Main Results:

• No significant differences in PJI rates were observed at 90 days, 6 months, 9 months, or 1 year between the colonoscopy and control groups.
• Direct comparison of colonoscopy groups (with and without prophylaxis) showed no significant PJI rate differences at any time point.
• Odds ratios for PJI between colonoscopy cohorts ranged from 1.07-1.43.

Conclusions:

• Invasive colonoscopy does not increase PJI risk in patients with pre-existing knee implants.
• Antibiotic prophylaxis may not be necessary for patients undergoing colonoscopy with a planned biopsy.
• Findings suggest current clinical guidelines may not require modification regarding antibiotic prophylaxis for colonoscopies in this patient population.