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Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom

James Morris|Lee Hoggett|Sophie Rogers|John Ranson|Andrew Sloan
대한고관절학회 (The Korean Hip Society)|2023.12|Hip and Pelvis|제35권 제4호|pp. 228-232

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Knee jointArthroplastyProsthetic joint infectionHip jointProsthesis and implants

초록

Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterise patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

Abstract

Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterise patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

참고문헌 (32)

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관련 논문AI추천

Should a Urinary Tract Infection Be Treated before a Total Joint Arthroplasty?구경회, Javad Parvizi대한고관절학회 · Hip and Pelvis2019 · 제31권 제1호Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty구경회, 박찬호, 이영균대한고관절학회 · Hip and Pelvis2017 · 제29권 제1호Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound ComplicationsAlexander J. Lampley, Brian L. Dial, Cynthia L. Green, Rhett Hallows대한고관절학회 · Hip and Pelvis2018 · 제30권 제1호Evidence-based Approach for Prevention of Surgical Site InfectionAhmad Abbaszadeh, Javad Parvizi, Mehmet Kursat Yilmaz, Nursanem Celik, Saad Tarabichi대한고관절학회 · Hip and Pelvis2024 · 제36권 제3호Periprosthetic Knee Infection: Ten Strategies That WorkClaudio Diaz-Ledezma, Javad Parvizi, Priscilla Ku Cavanaugh대한슬관절학회 · Knee Surgery and Related Research2013 · 제25권 제4호A Review of the Literature on Culture­Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment강병훈, 김동희, 남대철, 문동규, 윤홍권, 이동영, 이상혁, 조성희, 황선철대한슬관절학회 · Knee Surgery and Related Research2017 · 제29권 제3호

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