Prophylactic antibiotics in elective hip and knee arthroplasty
C. J. Hickson, MBChB MEng MRCS, Core Surgical Trainee,1 D. Metcalfe, MSc, LLB, MRCS, Research Fellow, Center for Surgery and Public Health,,2 S. Elgohari, MSc (Epidemiology), Senior Scientist (Epidemiology), Department of Healthcare Associated Infections and Antimicrobial Resistance,3 T. Oswald, MRCP FRCPath, Consultant Microbiologist,4 J. P. Masters, BSc MRCS, Academic Clinical Fellow,5 M. Rymaszewska, MRCS, Orthopaedic Registrar,6 M. R. Reed, FRCS (Orth), Consultant Trauma and Orthopaedic Surgeon, Institute of Cellular Medicine,7 and A. P. Sprowson†, MD FRCS(Orth), Associate Professor, Warwick Orthopaedics8Hip Knee
Objectives
We wanted to investigate regional variations in the organisms reported to be causing peri-prosthetic infections and to report on prophylaxis regimens currently in use across England.
Methods
Analysis of data routinely collected by Public Health England’s (PHE) national surgical site infection database on elective primary hip and knee arthroplasty procedures between April 2010 and March 2013 to investigate regional variations in causative organisms. A separate national survey of 145 hospital Trusts (groups of hospitals under local management) in England routinely performing primary hip and/or knee arthroplasty was carried out by standard email questionnaire.
Results
Analysis of 189 858 elective primary hip and knee arthroplasty procedures and 1116 surgical site infections found statistically significant variations for some causative organism between regions. There was a 100% response rate to the prophylaxis questionnaire that showed substantial variation between individual trust guidelines. A number of regimens currently in use are inconsistent with the best available evidence.
Conclusions
The approach towards antibiotic prophylaxis in elective arthroplasty nationwide reveals substantial variation without clear justification. Only seven causative organisms are responsible for 89% of infections affecting primary hip and knee arthroplasty, which cannot justify such widespread variation between prophylactic antibiotic policies.
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