Controversies in Perioperative Antimicrobial Prophylaxis

Brooke K. Decker, M.D.; Alexander Nagrebetsky, M.D.; Pamela A. Lipsett, M.D.; Jeanine P. Wiener-Kronish, M.D.; Naomi P. O'Grady, M.D.


Anesthesiology. 2020;132(3):586-597. 

In This Article

Controversies in Orthopedic Procedures

Different Administration Protocols for Antibiotic Prophylaxis in Joint Replacements

Prosthetic joint infection is an expensive and destructive complication for patients. The only "accepted" antibiotic prophylaxis is within 1 h of the surgical incision, which decreases surgical site infection in primary joint surgeries.[108,109] Single-center studies of adding a 1-g dose of vancomycin to the cephalosporin prophylactic antibiotic documented a lower rate of prosthetic joint infection in primary total knee arthroplasties and total hip arthroplasties.[110] Notably, these patients also received antibiotic cement.

Another more controversial technique of prophylaxis is the administration of antibiotics into the bone, or intraosseous regional administration, to increase antibiotic concentrations near the prosthetic joints.[111,112] These studies have been small, and although they have shown increased concentrations of antibiotics, they have not evaluated patient outcomes

Intraoperative vancomycin powder has also been evaluated as a strategy to prevent infection. These studies have not been randomized. In one retrospective study of 115 patients,[113] 42 had received intraoperative vancomycin. There were no significant differences in the number of surgical site infections, need for multiple antibiotics, reoperations, or length of stay between the control group and vancomycin powder recipients.[113]