Single-Dose Perioperative Antibiotics Do Not Increase the Risk of Surgical Site Infection in Unicompartmental Knee Arthroplasty

Published:February 26, 2019DOI:https://doi.org/10.1016/j.arth.2019.02.041

      Abstract

      Background

      Unicompartmental knee arthroplasty (UKA) is commonly performed as an outpatient procedure. To facilitate this process, a single-dose intravenous (IV) perioperative antibiotic administration is required compared to 24-hour IV antibiotic dosing schedules that are typical of most inpatient arthroplasty procedures. There is a paucity of literature to guide surgeons on the safety of single-dose perioperative antibiotic administration for arthroplasty procedures, particularly those that will be performed in the outpatient setting. The purpose of this study is to evaluate a large series of UKA performed with single-dose vs 24-hour IV antibiotic coverage to determine the impact on risk for surgical site infection (SSI).

      Methods

      All UKA cases were evaluated from 2007 to 2017 performed by a single surgeon at an academic institution. There were 296 UKAs in the cohort: 40 were outpatient procedures receiving single-dose antibiotics and 256 were inpatient procedures receiving 24-hour antibiotics. No patients were prescribed adjuvant oral antibiotics. Mean age was 64 years, 50% were female, mean body mass index was 32 kg/m2, and mean follow-up was 4.1 years (range 1.0-10.4). Perioperative antibiotic regimen was evaluated and SSI, defined as occurring within 1 year of surgery, was abstracted through a prospective total joint registry and manual chart review.

      Results

      SSI occurred in 2 of 296 cases (0.7%) in the entire cohort, 2 of 256 inpatient UKAs (0.8%), and 0 of 40 outpatient UKAs (0%) (P = 1.00). One SSI was a deep infection occurring 6 weeks postoperatively that required 2-stage exchange and conversion to total knee arthroplasty. The other was a superficial infection treated with 2 weeks of oral antibiotics.

      Conclusion

      This study demonstrates a low SSI risk (0.8% or less) following UKA with both single-dose and 24-hour IV antibiotics. Administering single-dose perioperative antibiotics is safe for UKA, which should alleviate that potential concern for outpatient surgery.

      Level of Evidence

      Level III, Therapeutic.

      Keywords

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      References

        • Cross M.B.
        • Berger R.
        Feasibility and safety of performing outpatient unicompartmental knee arthroplasty.
        Int Orthop. 2014; 38: 443-447
      1. Antimicrobial prophylaxis for surgery.
        Treat Guidel Med Lett. 2012; 10: 73-78
        • AAOS
        Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty.
        2004 (Accessed online https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1027%20Recommendations%20for%20the%20Use%20of%20Intravenous%20Antibiotic%20Prophylaxis%20in%20Primary%20Total%20Joint%20Arthroplasy.pdf)
        • AlBuhairan B.
        • Hind D.
        • Hutchinson A.
        Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review.
        J Bone Joint Surg Br. 2008; 90: 915-919
        • Boxma H.
        • Broekhuizen T.
        • Patka P.
        • Oosting H.
        Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial.
        Lancet. 1996; 347: 1133-1137
        • Bratzler D.W.
        • Dellinger E.P.
        • Olsen K.M.
        • Perl T.M.
        • Auwaerter P.G.
        • Bolon M.K.
        • et al.
        • American Society of Health-System Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America
        Clinical practice guidelines for antimicrobial prophylaxis in surgery.
        Surg Infect (Larchmt). 2013; 14: 73-156
        • Bratzler D.W.
        • Hunt D.R.
        The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery.
        Clin Infect Dis. 2006; 43: 322-330
        • Kurtz S.M.
        • Lau E.
        • Schmier J.
        • Ong K.L.
        • Zhao K.
        • Parvizi J.
        Infection burden for hip and knee arthroplasty in the United States.
        J Arthroplasty. 2008; 23: 984-991
        • Buckley R.
        • Hughes G.N.
        • Snodgrass T.
        • Huchcroft S.A.
        Perioperative cefazolin prophylaxis in hip fracture surgery.
        Can J Surg. 1990; 33: 122-127
        • Garcia S.
        • Lozano M.L.
        • Gatell J.M.
        • Soriano E.
        • Ramon R.
        • Sanmiguel J.G.
        Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole.
        J Bone Joint Surg Am. 1991; 73: 1044-1048
        • Garotta F.
        • Pamparana F.
        Antimicrobial prophylaxis with ceftizoxime versus cefuroxime in orthopedic surgery. Ceftizoxime Orthopedic Surgery Italian Study Group.
        J Chemother. 1991; 3: 34-35
        • Gatell J.M.
        • Garcia S.
        • Lozano L.
        • Soriano E.
        • Ramon R.
        • SanMiguel J.G.
        Perioperative cefamandole prophylaxis against infections.
        J Bone Joint Surg Am. 1987; 69: 1189-1193
        • Hellbusch L.C.
        • Helzer-Julin M.
        • Doran S.E.
        • Leibrock L.G.
        • Long D.J.
        • Puccioni M.J.
        • et al.
        Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion—a prospective study.
        Surg Neurol. 2008; 70: 622-627
        • Heydemann J.S.
        • Nelson C.L.
        Short-term preventive antibiotics.
        Clin Orthop Relat Res. 1986; 205: 184-187
        • Kanellakopoulou K.
        • Papadopoulos A.
        • Varvaroussis D.
        • Varvaroussis A.
        • Giamarellos-Bourboulis E.J.
        • Pagonas A.
        • et al.
        Efficacy of teicoplanin for the prevention of surgical site infections after total hip or knee arthroplasty: a prospective, open-label study.
        Int J Antimicrob Agents. 2009; 33: 437-440
        • Karachalios T.
        • Lyritis G.P.
        • Hatzopoulos E.
        Antibiotic prophylaxis in the surgical treatment of peritrochanteric fractures: a comparative trial between two cephalosporins.
        Chemotherapy. 1990; 36: 448-453
        • Liebergall M.
        • Mosheiff R.
        • Rand N.
        • Peyser A.
        • Shaul J.
        • Kahane Y.
        • et al.
        A double-blinded, randomized, controlled clinical trial to compare cefazolin and cefonicid for antimicrobial prophylaxis in clean orthopedic surgery.
        Isr J Med Sci. 1995; 31: 62-64
        • Mollan R.A.
        • Haddock M.
        • Webb C.H.
        Teicoplanin vs cephamandole for antimicrobial prophylaxis in prosthetic joint implant surgery: (preliminary results).
        Eur J Surg Suppl. 1992; : 19-21
        • Periti P.
        • Stringa G.
        • Mini E.
        Comparative multicenter trial of teicoplanin versus cefazolin for antimicrobial prophylaxis in prosthetic joint implant surgery. Italian Study Group for Antimicrobial Prophylaxis in Orthopedic Surgery.
        Eur J Clin Microbiol Infect Dis. 1999; 18: 113-119
        • Ritter M.A.
        • Campbell E.
        • Keating E.M.
        • Faris P.M.
        Comparison of intraoperative versus 24 hour antibiotic prophylaxis in total joint replacement. A controlled prospective study.
        Orthop Rev. 1989; 18: 694-696
        • Suter F.
        • Avai A.
        • Fusco U.
        • Gerundini M.
        • Caprioli S.
        • Maggiolo F.
        Teicoplanin versus cefamandole in the prevention of infection in total hip replacement.
        Eur J Clin Microbiol Infect Dis. 1994; 13: 793-796
        • Wymenga A.
        • van Horn J.
        • Theeuwes A.
        • Muytjens H.
        • Slooff T.
        Cefuroxime for prevention of postoperative coxitis. One versus three doses tested in a randomized multicenter study of 2,651 arthroplasties.
        Acta Orthop Scand. 1992; 63: 19-24
        • Kozinn S.C.
        • Scott R.
        Unicondylar knee arthroplasty.
        J Bone Joint Surg Am. 1989; 71: 145-150
        • Kozinn S.C.
        • Scott R.D.
        Surgical treatment of unicompartmental degenerative arthritis of the knee.
        Rheum Dis Clin North Am. 1988; 14: 545-564
        • Namba R.S.
        • Chen Y.
        • Paxton E.W.
        • Slipchenko T.
        • Fithian D.C.
        Outcomes of routine use of antibiotic-loaded cement in primary total knee arthroplasty.
        J Arthroplasty. 2009; 24: 44-47
        • Gandhi R.
        • Backstein D.
        • Zywiel M.G.
        Antibiotic-laden bone cement in primary and revision hip and knee arthroplasty.
        J Am Acad Orthop Surg. 2018; 26: 727-734
        • King J.D.
        • Hamilton D.H.
        • Jacbos C.A.
        • Duncan S.T.
        The hidden cost of commercial antibiotic-loaded bone cement: a systematic review of clinical results and cost implications following total knee arthroplasty.
        J Arthroplasty. 2018; 33: 3789-3792