Prophylaxis with teicoplanin and cefuroxime reduces the rate of prosthetic joint infection after primary arthroplasty.
The aim of this study was to compare the prosthetic joint infection (PJI) rate after total joint arthroplasty in two consecutive periods of treatment with different antibiotic prophylaxes: cefuroxime versus cefuroxime plus teicoplanin. We retrospectively reviewed 1,896 patients who underwent total hip arthroplasty or total knee arthroplasty between March 2010 and February 2013. From March 2010 to August 2011, patients received 1.5 g of cefuroxime during induction of anesthesia and another 1.5 g 2 h later (the C group). From September 2011, 800 mg of teicoplanin was added to cefuroxime (the CT group). Throughout the period studied, there were no variations in pre- or postoperative protocols. Univariate and multivariate analyses were performed to evaluate independent predictors of PJI. There were 995 (55.7%) patients in the C group and 791 (44.3%) in the CT group. Patients in the CT group had a significantly lower PJI rate than patients in the C group (1.26% versus 3.51%, P=0.002). There were no infections due to Staphylococcus aureus in the CT group (0% versus 1.6% in the C group, P<0.001). A stepwise forward Cox regression model identified male sex (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.09 to 7.18), a body mass index of ≥35 kg/m2 (HR, 2.93; 95% CI, 1.37 to 6.27), the presence of lung disease (HR, 2.46; 95% CI, 1.17 to 5.15), and red blood cell transfusion (HR, 3.70; 95% CI, 1.89 to 7.23) to be independent variables associated with a higher risk of PJI. The addition of teicoplanin was associated with a lower risk of infection (HR, 0.35; 95% CI, 0.17 to 0.74). In conclusion, the addition of teicoplanin to cefuroxime during primary arthroplasty was associated with a significant reduction in the global PJI rate due to a reduction of infections caused by Gram-positive bacteria.
Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
Eduard
E
Tornero
Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
Sebastian
S
García-Ramiro
Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
Juan C
JC
Martínez-Pastor
Department of Traumatology and Orthopaedic Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
Guillem
G
Bori
Service of Microbiology, Hospital Clinic of Barcelona, Barcelona, Spain.
Jordi
J
Bosch
Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain.
Laura
L
Morata
Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain.
Marta
M
Sala
Service of Anaesthesiology, Hospital Clinic of Barcelona, Barcelona, Spain.
Misericordia
M
Basora
Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain.
Josep
J
Mensa
Service of Infectious Diseases, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain asoriano@clinic.ub.es.
Alex
http://orcid.org/0000-0002-9374-0811
A
Soriano
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee; D002444:Cefuroxime / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D017334:Teicoplanin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D002444:Cefuroxime