Noncefazolin Antibiotic Prophylaxis Is Associated With Increased Periprosthetic Joint Infection Risk Following Total...

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Pharmacology

Background:

• Conflicting evidence exists regarding antibiotic choice and periprosthetic joint infection (PJI) risk following total knee arthroplasty (TKA).
• A national database was utilized to assess the impact of cefazolin versus alternative antibiotics on PJI incidence.

Purpose of the Study:

• To investigate whether cefazolin prophylaxis reduces the risk of PJI after primary total knee arthroplasty (TKA).
• To compare PJI rates among patients receiving cefazolin-only, cefazolin with another antibiotic, or non-cefazolin prophylaxis.

Main Methods:

• A national database (2016-2022) was queried for primary TKA procedures (CPT 27447).
• Over 528,000 TKA patients were analyzed, categorized by antibiotic prophylaxis: cefazolin-only, cefazolin plus another antibiotic, or non-cefazolin.
• Periprosthetic joint infection (PJI) within 90 days was identified using CMS complication codes. Multinomial logistic regression was employed for analysis.

Main Results:

• Univariate analysis revealed lower 90-day PJI rates (0.7%) for cefazolin-based prophylaxis compared to non-cefazolin (1.0%).
• Adjusted analysis demonstrated that both cefazolin-only (OR 0.68) and cefazolin plus another antibiotic (OR 0.74) were significantly associated with reduced PJI odds.
• These associations remained statistically significant (P < 0.001) after controlling for patient demographics and comorbidities.

Conclusions:

• Nationally representative data confirm that cefazolin prophylaxis significantly decreases the 90-day PJI risk after TKA compared to alternative antibiotic regimens.
• Surgeons should prioritize cefazolin-based prophylaxis, considering patient allergies as a primary reason for deviation.
• Further research is needed to establish optimal antibiotic strategies for patients with cefazolin allergies or those at elevated infection risk.