Not So Fast: Extended Oral Antibiotic Prophylaxis Does Not Reduce 90-Day Infection Rate Following Joint Arthroplasty

Jade B Flynn; Sanar S Yokhana; Jacob M Wilson; Jacob D Schultz; Alicia Hymel; J Ryan Martin

doi:10.1016/j.arth.2024.04.064

Not So Fast: Extended Oral Antibiotic Prophylaxis Does Not Reduce 90-Day Infection Rate Following Joint Arthroplasty

J Arthroplasty. 2024 Apr 27:S0883-5403(24)00412-1. doi: 10.1016/j.arth.2024.04.064. Online ahead of print.

Authors

Jade B Flynn¹, Sanar S Yokhana², Jacob M Wilson², Jacob D Schultz², Alicia Hymel², J Ryan Martin²

Affiliations

¹ Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232. Electronic address: jade.flynn@vumc.org.
² Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232.

PMID: 38685337
DOI: 10.1016/j.arth.2024.04.064

Abstract

Introduction: Periprosthetic joint infection (PJI) is a devastating complication following both total hip (THA) and knee (TKA) arthroplasty. Extended oral antibiotic prophylaxis (EOA) has been reported to reduce PJI following TJA in high-risk patients. The purpose of this study was to determine if EOA reduces PJI in all-comers and high-risk THA and TKA populations.

Methods: This is a retrospective cohort study, including 4,576 patients undergoing primary THA or TKA at a single institution from 2018 to 2022. Beginning in 2020, EOA prophylaxis was administered for 10 days following THA or TKA at our institution. Patients were separated into two cohorts (1,769 EOA, 2,807 no EOA) based on whether they received postoperative EOA. The 90-day and 1-year outcomes, with a focus on PJI, were then compared between groups. A subgroup analysis of high-risk patients was also performed.

Results: There was no difference in 90-day PJI rates between cohorts (EOA 1 versus no EOA 0.8%; P = 0.6). The difference in the rate of PJI remained insignificant at 1 year (EOA 1 versus no EOA 1%; P = 0.9). Similarly, our subgroup analysis of high-risk patients demonstrated no difference in postoperative PJI between EOA (n = 254) and no EOA (n = 396) (0.8 versus 2.3%, respectively; P = 0.2). Reassuringly, we also found no differences in the incidence of Clostridium difficile infection (CDI) (EOA 0.1 versus no EOA 0.1%; P > 0.9) or in antibiotic resistance among those who developed PJI within 90 days (EOA 59 versus no EOA 83%; P = 0.2).

Discussion: With the numbers available for analysis, extended oral antibiotic prophylaxis was not associated with PJI risk reduction following primary TJA when universally deployed. Furthermore, among high-risk patients, there was no statistically significant difference. While we did not identify increased antibiotic resistance or CDI, we cannot recommend wide-spread adoption of EOA prophylaxis, and clarification regarding the role of EOA, even in high-risk patients, is needed.

Keywords: antibiotics; infection; infection prevention; periprosthetic joint infection; total hip arthroplasty.