Antimicrobial prophylaxis with teicoplanin plus gentamicin in primary total joint arthroplasty

Tari Azamgarhi; Craig Gerrand; John A Skinner; Alexander Sell; Robert A McCulloch; Simon Warren

doi:10.5194/jbji-8-219-2023

Antimicrobial prophylaxis with teicoplanin plus gentamicin in primary total joint arthroplasty

J Bone Jt Infect. 2023 Oct 30;8(6):219-227. doi: 10.5194/jbji-8-219-2023. eCollection 2023.

Authors

Tari Azamgarhi¹, Craig Gerrand², John A Skinner^{3

4}, Alexander Sell⁵, Robert A McCulloch⁶, Simon Warren^{7

8}

Affiliations

¹ Pharmacy Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
² Division of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
³ Research and Innovation Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
⁴ Division of Surgery and Interventional Science, University College London, London, WC1E 6BT, UK.
⁵ Department of Anaesthesia, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
⁶ Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
⁷ Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust, Stanmore, HA7 4LP, UK.
⁸ The Royal Free Hospital NHS Foundation Trust, Hampstead, London, NW3 2QG, UK.

Abstract

Objectives: To compare prosthetic joint infection (PJI) and acute kidney injury (AKI) rates among cohorts before and after changing our hospital's antimicrobial prophylactic regimen from cefuroxime to teicoplanin plus gentamicin. Methods: We retrospectively studied all patients undergoing primary total joint arthroplasty at our hospital 18 months pre- and post-implementation of the change in practice. All deep infections identified during follow-up were assessed against the European Bone and Joint Infection Society (EBJIS) definitions for PJI. Survival analysis using Cox regression was employed to adjust for differences in baseline characteristics and compare the risk of PJI between the groups. AKIs were identified using pathology records and categorized according to the KDIGO (Kidney Disease - Improving Global Outcomes) criteria. AKI rates were calculated for the pre- and post-intervention periods. Results: Of 1994 evaluable patients, 1114 (55.9 %) received cefuroxime only (pre-intervention group) and 880 (44.1 %) patients received teicoplanin plus gentamicin (post-intervention group). The overall rate of PJI in our study was 1.50 % (30 of 1994), with a lower PJI rate in the post-intervention group (0.57 %; 5 of 880) compared with the pre-intervention group (2.24 %; 25 of 1114). A corresponding risk reduction for PJI of 75.2 % (95 % CI of 35.2-90.5; $p = 0$ .004) was seen in the post-intervention group, which was most pronounced for early-onset and delayed infections due to coagulase-negative staphylococci (CoNS) and cefuroxime-resistant Enterobacteriaceae. Significantly higher AKI rates were seen in the post-intervention group; however, 84 % of cases (32 of 38) were stage 1, and there were no differences in the rate of stage-2 or -3 AKI. Conclusions: Teicoplanin plus gentamicin was associated with a significant reduction in PJI rates compared with cefuroxime. Increases in stage-1 AKI were seen with teicoplanin plus gentamicin.