Should Preoperative Antibiotics Be Tailored According to Patient's Comorbidities and Susceptibility to Organisms?

Abstract

Background: Preoperative antibiotic prophylaxis remains one of the most important strategies for preventing periprosthetic joint infection (PJI). Current guidelines recommend giving universal antibiotic prophylaxis to all total joint arthroplasty patients regardless of their medical conditions or immune status; however, no studies have evaluated the individualizing of antibiotics. The aims of this study were (1) to determine if comorbidities influence the organism profile of PJIs, and (2) to investigate if the efficacy of two different perioperative antibiotics (cefazolin or vancomycin) for preventing PJI is affected by patient's comorbidities.

Methods: Using an institutional database of 1022 PJIs, the influence of different patient's comorbidities on the organism profile was evaluated. To investigate the influence of perioperative antibiotics (cefazolin or vancomycin monotherapy) on PJI rate, 8575 primary total joint arthroplasties were identified, crossmatched for PJI, and analyzed based on the comorbidities of the cohort. The PJI rate of each antibiotic within each comorbidity was compared.

Results: Although no comorbidities were associated with an increased rate of Gram-positive infections or Gram-negative infections, metastatic disease (odds ratio [OR] 5.71, P = .018), congestive heart failure (OR 2.2, P = .010), chronic pulmonary disease (OR 1.76, P = .015), and diabetes mellitus (OR 1.66, P = .019) were associated with antibiotic resistant organisms. However, there was no difference in the PJI rate between cefazolin and vancomycin monotherapy when stratifying for diabetes mellitus, rheumatoid arthritis, liver disease, and hypothyroidism.

Conclusion: The results of the present study support the current recommendations of a universal antibiotic prophylaxis protocol rather than an antibiotic regimen individualized to a patient's comorbidities.

Keywords: comorbidities; organisms; periprosthetic joint infection; preoperative antibiotics; prophylaxis; total joint arthroplasty.