PROPHYLACTIC CEFAZOLIN VERSUS PLACEBO IN TOTAL HIP REPLACEMENT Report of a Multicentre Double-blind Randomised Trial

doi:10.1016/S0140-6736(81)92678-7

The Lancet

Volume 317, Issue 8224, 11 April 1981, Pages 795-797

https://doi.org/10.1016/S0140-6736(81)92678-7 Get rights and content

Abstract

The effect of five days of antibiotic prophylaxis with cefazolin injections (beginning just before surgery) on postoperative infectious complications was evaluated in a double-blind, randomised, placebo-controlled trial in nine centres on 2137 patients undergoing hip replacement. Antibiotic prophylaxis reduced the number of hip infections significantly from 3·3% (placebo) to 0·9% (cefazolin). Positive peroperative blood samples and positive bacteriological examination of the drain were risk factors for hip infection but the prognostic value of obesity, diabetes, or previous hip surgery was not confirmed. Development of a urinary infection was not related to hip infection. Hip infections were less common in the four centres with hypersterile operating theatres, and the benefits of prophylactic antibiotics were restricted to patients having hip replacement operations in conventional theatres.

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Cited by (291)

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There is growing interest in extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA); however, the benefit of EAP remains controversial. For this investigation, both oral and intravenous antibiotic protocols were included in the EAP group.
The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, Ovid Embase, Elton B. Stephens CO, and Cumulative Index to Nursing and Allied Health Literature were queried for literature comparing outcomes of primary and aseptic revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients who were treated with either ≤24 hours of postoperative antibiotic prophylaxis (standard of care [SoC]) or >24 hours of EAP. The primary outcome was periprosthetic joint infection (PJI). A pooled relative-risk random-effects Mantel-Haenszel model was implemented to compare cohorts.
There were 18 studies with a total of 19,153 patients included. There was considerable variation in antibiotic prophylaxis protocols with first-generation cephalosporins being the most commonly implemented antibiotic for both groups. Patients treated with EAP were 35% less likely to develop PJI relative to the SoC (P = .0004). When examining primary TJA, patients treated with EAP were 39% and 40% less likely to develop a PJI for TJA (P = .0008) and THA (P = .02), respectively. There was no significant difference for primary TKA (P = .17). When examining aseptic revision TJA, EAP led to a 36% and 47% reduction in the probability of a PJI for aseptic revision TJA (P = .007) and aseptic revision TKA (P = .008), respectively; there was no observed benefit for aseptic revision THA (P = .36).
This meta-analysis demonstrated that patients treated with EAP were less likely to develop a PJI relative to those treated with the SoC for all TJA, primary TJA, primary THA, aseptic revision TJA, and aseptic revision TKA. There was no significant difference observed between EAP and SoC for primary TKA or aseptic revision THA.
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2023, Orthopaedics and Trauma
Surgical site infections (SSI) continue to represent a significant postoperative burden. SSI is associated with an increased risk of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) is used to reduce the risk of SSI. Several factors must be considered for appropriate antibiotic use: antibiotic selection, timing, and duration. The evidence and use of antibiotics differs between closed fractures, open fractures, arthroplasty and percutaneous fixation. The use of SAP is a balance between reducing the incidence of SSI whilst maintaining proper antibiotic stewardship to limit adverse effects and the emergence of antibiotic resistance. This paper will discuss the evidence for the use of SAP in orthopaedic surgery and the potential adverse effects of the injudicious use of antibiotics.
Prevention Techniques Have Had Minimal Impact on the Population Rate of Prosthetic Joint Infection for Primary Total Hip and Knee Arthroplasty: A National Database Study
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Several studies over the years have offered modalities that may greatly decrease the rate of periprosthetic joint infection when implemented. As a result, one would expect a drastic decrease in infection rate among the implementing population with its widespread use. The purpose of this study was to assess whether there exists a decrease in infection rate over time, after accounting for available confounding variables, within a large national database.
A large national database from 2005 to 2019 was queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). In total, 221,416 THAs and 354,049 TKAs were performed over the study period. Differences in 30-day infection rate were assessed with time and available preoperative risk factors using multinominal logistic regressions.
Rate of infection overall trended downward for both THA and TKA. After accounting for confounding variables, odds of THA infection marginally decreased over time (odds ratio 0.968 [0.952-0.985], P < .0001), while the odds of a TKA infection marginally increased with time (odds ratio 1.037 [1.020-1.054], P < .0001).
Individual peer-reviewed publications have presented infection control modalities demonstrating dramatic decreases in infection rate while analysis at a population level shows almost no changes in infection rate over a 15-year time period. This study supports continued investigation for influential modalities in preventing periprosthetic joint infection and care in patient selection for primary hip and knee arthroplasty.
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2021, Bionanocomposites in Tissue Engineering and Regenerative Medicine
Bone disorders are increasing day by day due to various clinical situations, dietary habits, and the western lifestyle. One such bone defect, resulting in earlier fractures, morbidity, and mortality, is the osteoporosis. From the last two decades, the scientific community is making much effort to prevent and treat osteoporosis and the related bone ailments. A number of antibone resorption drugs, bone anabolic drugs, supplements, and probiotics are in the queue but all with one or another side effect. Also, a variety of synthetic bone substitutes, which are developed from various types of metals, ceramics, polymers, etc., are introduced, but their safety, efficacy, and effectiveness always remained uncertain. So, some special type of bone repairing material with reduced scar size, operation time, healing time, and postoperative pain is warranted. One such material with all these properties is the chitosan and chitosan-based bionanocomposites. Chitosan can fulfill all the desired properties like high osteoconductivity, osteointegratability, gradual biodegradability, and easy application. These properties of chitosan thus proved it to be a good candidate for bone repair and regeneration.
Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review
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Antibiotic stewardship is now a priority for the urologic community. Perioperative antibiotic use at the time of inflatable penile prosthesis (IPP) insertion has become a topic of interest.
To review the literature available to inform the practice of antibiotic administration before, during, and after IPP insertion.
We performed a literature review based on a search for the terms “Antibiotics” and “Penile Prosthesis” in the PubMed database. Manuscripts were individually reviewed for relevance to the administration of antibiotics in conjunction with IPP insertion. Best practice statements and guidelines from stakeholder organizations were also reviewed.
The benefits of preoperative antibiotic prophylaxis have been well studied in the orthopedic and general surgery literature, but a dearth of studies are available in the specific context of IPP insertion. High-quality retrospective studies have demonstrated reduced infection rates with the use of antibiotic-impregnated or antibiotic-coated IPPs. Limited research on the use of postoperative antibiotics after IPP insertion has actually not demonstrated a benefit from this very common practice. Indeed, the broader surgical literature suggests a net harm from continued postoperative antibiosis. A 2017 guideline recommendation from the Center for Disease Control and Prevention states that additional prophylactic antibiotics should not be administered after procedures deemed clean or clean-contaminated.
The benefits of single-dose preoperative antibiotics and the use of antibiotic-impregnated or antibiotic-coated IPPs are well established. Postoperatively, the available IPP and broader surgical literature does not reflect a benefit from the administration of additional antibiotics and demonstrates higher rates of antibiotic-associated adverse events and the emergence of drug resistance. In average-risk patients undergoing IPP insertion, contemporary data suggest that it is safe for postoperative antibiotics to be withheld.
Dropkin BM, Kaufman MR. Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review. Sex Med 2021;9:174–180.
Surgical site infections following elective surgery
2020, The Lancet Infectious Diseases

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^☆: Clinicians taking part were members of Groupe d'Etude du Traitement Préventif de l'Infection dans les Arthroplasties: J. H. AUBRIOT (Caen), J. BABIN-CHEVAYE (Nantes), J. CASTAING (Tours), B. COURTOIS (Brest), J. LEWALLE (Ottignies), P. MAURER (Paris), F. MAZAS (Paris), M. POSTEL (Paris), and J P. RUELLE (Chateaubriant).

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PROPHYLACTIC CEFAZOLIN VERSUS PLACEBO IN TOTAL HIP REPLACEMENT Report of a Multicentre Double-blind Randomised Trial☆

Abstract

Antibiotic prophylaxis in total hip replacement

Br Med J

Critical reevaluation of antibiotic therapy in surgery

JAMA

Postoperative wound infection. 5-year review of 1163 consecutive operative orthopedic patients

Am Surg

Postoperative wound infections in orthopedic surgery. Evaluation of prophylactic antiobiotics

J Int Coll Surg

Postoperative orthopaedic infections: a study of etiological mechanisms

J Bone Joint Surg

The effective period of preventive antibiotic action in experimental incisions and dermal lesions

Surgery

Prophylactic penicillin and streptomycin in elective operations on bones, joints and tendons

Surg Forum

Wound sepsis in orthopedic surgery

J Bone Joint Surg