Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single-dose is as Effective as Multiple-doses

Background: Recent surgical site infection prevention guidelines recommend that no additional prophylactic antibiotics be administered after the surgical incision is closed in clean-contaminated procedures. Although there is ample evidence to support this recommendation in non-arthroplasty surgery, there is concern about extending these guidelines to surgeries with an implant such as total joint arthroplasty (TJA). The aim of
this study is to compare the efficacy of a single-dose of prophylactic antibiotics versus multiple-doses of antibiotics in prevention of periprosthetic joint infection (PJI) in patients undergoing TJA and review pertinent literature.

Methods: A retrospective study of 20,682 primary TJAs from 2006 to 2014 was performed. Patients who received a single-dose of prophylactic antibiotics (n=4,523) were compared with patients who received multiple-doses of antibiotics (n=16,159). A previously validated, PJI risk score was assigned to each patient. Patients who developed PJI within one year were identified and a multivariate logistic regression
analysis was performed to control for potential confounders.

Results: The overall PJI rate was 0.60% (27/4523) in patients who received a singledose of antibiotic compared to 0.87% (142/16159) in patients receiving multiple-doses of antibiotics. There was no difference in the PJI rate between patients who received a single-dose and those who received multiple-doses of antibiotics in both the univariate (OR 0.674, p=0.064) or the multivariate analyses (OR 0.708, p=0.107). Furthermore, multiple-doses did not demonstrate any additional benefit for patients with a high preoperative risk of PJI (adjusted OR 0.981, p=0.943).

Conclusion: This study supports the notion that the administration of additional antibiotics following skin closure may not be required in patients undergoing primary TJA, regardless of their preoperative risk of PJI. The findings of this large retrospective study combined with the body of existing literature highlight the need for a randomized, prospective study to base current guidelines on.