Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty

Journal article


Hawke, Helen, Churches, Tim, Xuan, Wei, Naylor, Justine and Harris, Ian A.. (2022). Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty. Bone and Joint Open. 3(3), pp. 252-260. https://doi.org/10.1302/2633-1462.33.BJO-2021-0181.R1
AuthorsHawke, Helen, Churches, Tim, Xuan, Wei, Naylor, Justine and Harris, Ian A.
Abstract

Aims: Antibiotic prophylaxis involving timely administration of appropriately dosed antibiotic is considered effective to reduce the risk of surgical site infection (SSI) after total hip and total knee arthroplasty (THA/TKA). Cephalosporins provide effective prophylaxis, although evidence regarding the optimal timing and dosage of prophylactic antibiotics is inconclusive. The aim of this study is to examine the association between cephalosporin prophylaxis dose, timing, and duration, and the risk of SSI after THA/TKA.

Methods: A prospective multicentre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKA/THA at one of 19 high-volume Australian public/private hospitals. Data were collected prior to and for one-year post surgery. Logistic regression was undertaken to explore associations between dose, timing, and duration of cephalosporin prophylaxis and SSI. Data were analyzed for 1,838 participants. There were 264 SSI comprising 63 deep SSI (defined as requiring intravenous antibiotics, readmission, or reoperation) and 161 superficial SSI (defined as requiring oral antibiotics) experienced by 249 (13.6%) participants within 365 days of surgery.

Results: In adjusted modelling, factors associated with a significant reduction in any SSI and deep SSI included: correct weight-adjusted dose (any SSI; adjusted odds ratio (aOR) 0.68 (95% confidence interval (CI) 0.47 to 0.99); p = 0.045); commencing preoperative cephalosporin within 60 minutes (any SSI, aOR 0.56 (95% CI 0.36 to 0.89); p = 0.012; deep SSI, aOR 0.29 (95% CI 0.15 to 0.59); p < 0.001) or 60 minutes or longer prior to skin incision (aOR 0.35 (95% CI 0.17 to 0.70); p = 0.004; deep SSI, AOR 0.27 (95% CI 0.09 to 0.83); p = 0.022), compared to at or after skin incision. Other factors significantly associated with an increased risk of any SSI, but not deep SSI alone, were receiving a non-cephalosporin antibiotic preoperatively (aOR 1.35 (95% CI 1.01 to 1.81); p = 0.044) and changing cephalosporin dose (aOR 1.76 (95% CI 1.22 to 2.57); p = 0.002). There was no difference in risk of any or deep SSI between the duration of prophylaxis less than or in excess of 24 hours.

Conclusion: Ensuring adequate, weight-adjusted dosing and early, preoperative delivery of prophylactic antibiotics may reduce the risk of SSI in THA/TKA, whereas the duration of prophylaxis beyond 24 hours is unnecessary.

KeywordsAnthroplasty; Clinical practice guidelines; Complications; Prophylaxis; Venous thromboembolism; Infection; Hip; Knee
Year01 Jan 2022
JournalBone and Joint Open
Journal citation3 (3), pp. 252-260
PublisherBritish Editorial Society of Bone and Joint Surgery
ISSN2633-1462
Digital Object Identifier (DOI)https://doi.org/10.1302/2633-1462.33.BJO-2021-0181.R1
Web address (URL)https://boneandjoint.org.uk/Article/10.1302/2633-1462.33.BJO-2021-0181.R1
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range252-260
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online17 Mar 2022
Publication process dates
AcceptedMar 2022
Deposited10 Jun 2024
Additional information

© 2022 Author(s) et al.

This is an open- access article distributed under the terms of the Creative Commons Attribution Non- Commercial No Derivatives (CC BY- NC- ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

The open access funding for this study was obtained through the HCF Health and Medical Research Foundation (Grant number IHIIAMR2012073043).

Place of publicationUnited Kingdom
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