Meeting Coverage > > AAOS– One center’s experience puts current policy in doubt
by John Gever, Contributing Writer, MedPage Today February 13, 2024
SAN FRANCISCO– Routinely offering antibiotic prophylaxis for 10 days in arthroplasty clients obviously did absolutely nothing beyond what was accomplished with much shorter procedures to avoid prosthetic joint infections (PJIs) at one significant medical.
PJI rates at Vanderbilt University Medical Center in Nashville were no lower after a policy was carried out in 2020 to supply prolonged oral prescription antibiotics to all clients going through overall hip or knee replacement, according to Vanderbilt’s J. Ryan Martin, MD, speaking here at the American Academy of Orthopaedic Surgeons yearly conference.
Amongst an overall of about 4,600 knee and hip replacement treatments done from 2018 to 2022, clients getting extended oral prescription antibiotics experienced PJIs within 90 days at a rate of 0.96%, versus 0.82% of clients just getting perioperative prescription antibiotics, Martin reported.
1 year PJI rates likewise revealed no genuine distinction: 0.96% with extended oral prescription antibiotics (i.e., no brand-new infections were seen after 90 days) as compared to 1% of clients who didn’t get extended oral prescription antibiotics.
Martin stated, “we can not advise prevalent adoption” of extended oral prescription antibiotics for avoiding PJIs after arthroplasty.
Vanderbilt’s relocation in 2020 to offer prolonged oral prescription antibiotics consistently in joint replacements– echoed at numerous other centers– was triggered by a retrospective research study appearing in late 2018. It revealed that extended oral prescription antibiotics had actually cut rates of PJIs by 75% to 80% in high-risk clients. With such a decrease in this crucial problem of arthroplasty, which typically causes modification, lots of clinicians felt that continuing with basic perioperative prophylaxis would be dishonest. After taking a look at this and other research studies, Vanderbilt chose to make a 10-day postoperative program of oral prescription antibiotics the requirement of care. (Other extended oral antibiotic procedures have actually set the duration at 7 days.)
The prolonged treatment is not without possible damages, Martin kept in mind. It may promote advancement of antibiotic resistance, and some clients experience direct negative impacts from the drugs.
The brand-new research study reduced the previous issue. Just 2 of some 1,800 clients getting extended oral prescription antibiotics at Vanderbilt revealed antibiotic resistance, versus 5 of about 2,800 provided basic perioperative prescription antibiotics.
Martin’s group did discover a tip of gain from extended oral prescription antibiotics amongst clients thought about to be at high danger for PJIs, who had to do with half of the whole friend. In this subgroup, 90-day and 1-year PJI rates were substantially greater in the group who didn’t get extended oral prescription antibiotics: 2.3% and 2.6%, respectively, versus 0.8% with extended oral prescription antibiotics. Neither distinction reached analytical significance.
Asked throughout the audience Q&A whether Martin saw any function for extended oral prescription antibiotics in arthroplasty, he responded, “I still believe there might be some,” such as clients with anticipated PJI threat of 4% or more.
He informed MedPage Today that Vanderbilt hasn’t yet officially deserted the all-comers policy for extended oral prescription antibiotics.