title: Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures.
abstract: BACKGROUND
  Culture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures.
  
  
  METHODS
  An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital. Patients were prospectively randomized into two groups. The control group received the classical preoperative antibiotic prophylaxis. The study group did not receive prophylaxis prior to surgery.
  
  
  RESULTS
  There were 14 patients in each group. They correspond to 13 total hip arthroplasty infections, 12 total knee arthroplasty infections and 3 reverse shoulder prosthesis infections. There were 10 patients in the study group and 10 patients in the control group with at least one positive microbiological criterion (P > 0.05). There were 4 patients in each group with a culture negative PJI (P > 0.05).
  
  
  CONCLUSIONS
  Preoperative antibiotic prophylaxis does not affect intraoperative cultures in suspected or confirmed PJI. Therefore it is essential to deliver antibiotic prophylaxis in any patient in which a prosthesis is to be implanted in order to protect the prosthesis from infection.
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: dperezprieto@parcdesalutmar.cat.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pérez-Prieto
authors.affiliation: Clinical Microbiology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Portillo
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Puig-Verdié
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Alier
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gamba
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Guirro
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Martínez-Díaz
authors.affiliation: Infectious Diseases Department, Hospital del Mar-IMIM, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.affiliation: Center for Septic Surgery, Charité - University Medicine, Berlin, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
authors.affiliation: Orthopedic Department, Hospital del Mar - Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Monllau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000175:diagnosis* / Q000601:surgery*; D001431:Bacteriological Techniques; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000601:surgery*; D011897:Random Allocation; D012680:Sensitivity and Specificity
keywords: Antibiotic prophylaxis; Biofilm; Prosthetic joint infection; Sonication