Summary
LOCAL ANTIBIOTIC PROPHYLAXYS IN PJI
Abstract
Objectives
The influence of local antibiotic therapy in orthopedic surgery remains unclear. In this trial, we evaluated the incidence of periprosthetic joint infections (PJI), after local or intravenous (IV) antibiotic prophylaxis. The aim of this intervention was to compare the PJI incidence in a population with non-modifiable risk factors after local prophylaxis with vancomycin loaded calcium sulfate beads versus a control group.
Methods
A total of 83 subjects were evaluated, inclusion criteria included participants over 60 years of age, with at least one main risk factor for PJI who underwent total hip or knee joint replacement between June 2019 and May 2020. Cases were randomized, the intervention group received local prophylactic antibiotic therapy with calcium sulfate beads impregnated with vancomycin; conventional IV prophylactic antibiotic therapy was administered for the control group. C reactive protein (CRP) and erythrocyte sedimentation rate (ERS) serum biomarkers were analyzed on day 5 and weeks 4, 8, and 12. When needed synovial fluid sample was obtained and cultured for the early acute PJI diagnosis.
Results
Acute PJI was found in 27 patients (67.5%) in the control group and 4 (9.3%) for the intervention group. Variable analysis identified that local prophylaxis with calcium sulfate beads reduce the incidence of acute knee or hip PJI in patients with non-modifiable risk factors compared to conventional prophylaxis (p < 0.0001) with a relative risk of 0.13 (CI:0.05-0.35). Length of hospital stay was also shorter in the intervention group at 4.6 days, compared to 15.25 days in the control group; p < 0.001.
Conclusions
Local antibiotic prophylaxis in patients with non-modifiable risk factors undergoing hip or knee replacement, reduces the incidence of acute PJI compared to IV antibiotics.