Antibiotic Prophylaxis and Empirical Antibiotic Therapy in Primary Arthroplasty and Periprosthetic Joint Infections: Current Practice and Need for Therapy Optimization

Abstract

The aim of the present work was to survey the situation of healthcare regarding the use of prophylactic and empirical antibiotics in primary arthroplasty and treatment of periprosthetic joint infections (PJI). For this purpose, a survey was conducted at German university and occupational accident hospitals. Survey data was compared to previously published data on the antimicrobial regimes of PJI (n=81) patients (n=81) treated in our department between 2017 and 2020. A homogeneous picture emerged for the prophylactic administration of antibiotics in the context of primary arthroplasty. In 93.2% (elective) and 88.6% (fracture treatment) of the hospitals, first or second generation cephalosporins were administered perioperatively for infection prophylaxis in primary hip arthroplasty. The empirical antibiotic treatment of PJIs showed a clearly inhomogeneous therapeutic picture. Monotherapy with an aminopenicillin plus a beta-lactamase inhibitor is used most frequently (38.7%); first and second generation cephalosporins are used second most frequently as monotherapy (18.2%). In light of the global problem of antibiotic multi-resistance, clinical use of antibiotics has to be reasonable and effective. The present results highlight the further need to improve awareness and following existing guidelines in the administration of empirical antibiotic therapy in PJI.

Zusammenfassung

Das Ziel der vorliegenden Arbeit ist es, die Versorgungssituation in Deutschland in Hinblick auf den Nutzen prophylaktischer und empirischer Antibiotikatherapie zu erheben. Unterschieden wird zwischen primärer Endoprothetik und der Versorgung periprothetischer Gelenkinfektionen (PJI). Zu diesem Zweck wurde eine Umfrage in deutschen Universitätskliniken und BG-Kliniken (Fachbereiche Orthopädie und/oder Unfallchirurgie) mittels Fragebogen durchgeführt. Die daraus resultierenden Umfragedaten wurden anschließend mit zuvor veröffentlichten Daten zur antimikrobiellen Behandlung von n=81 PJI-Patienten, die zwischen 2017 und 2020 in unserer Abteilung behandelt wurden, verglichen.

Hinsichtlich der prophylaktischen Antibiotikagabe im Kontext der Primärendoprothetik ergab sich ein homogenes Bild. In 93,2 % (elektiv) und 88,6 % (Frakturbehandlung) der Kliniken wurden Cephalosporine der 1. und 2. Generation perioperativ zur Infektionsprophylaxe bei der primären Hüftendoprothetik verabreicht.

Die empirische Verabreichung von Antibiotika bei PJI zeigte ein deutlich inhomogeneres therapeutisches Bild. Am häufigsten wird eine Monotherapie mit einem Aminopenicillin/Betalaktamase-Inhibitor verordnet (38,7%); Cephalosporine der 1. und 2. Generation werden am zweithäufigsten im Rahmen einer Monotherapie eingesetzt (18,2%).

Angesichts des globalen Problems der zunehmenden Antibiotikamultiresistenz muss der klinische Einsatz von Antibiotika sinnvoll und wirksam sein. Die vorliegenden Ergebnisse unterstreichen die Notwendigkeit, das Bewusstsein hierfür zu schärfen und bestehende Leitlinien zur Verabreichung empirischer Antibiotikatherapie bei PJI zu beachten.

Keywords

antibiotic prophylaxis - empirical antibiotic therapy - periprosthetic joint infections - arthroplasty - joint replacement

Schlüsselwörter

Antibiotikaprophylaxe - empirische Antibiotikatherapie - periprothetische Gelenkinfektion - Endoprothetik - Gelenkersatz

^* This article is a republished version of: Rupp M, Walter N, Baertl S, Lang S, Herbst T, Hitzenbichler F, Alt V. Antibiotic Prophylaxis and Empirical Antibiotic Therapy in Primary Arthroplasty and Periprosthetic Joint Infections: Current Practice and Need for Therapy Optimization. Z Orthop Unfall 2023;161(6):654–659.

Publication History

Article published online:
09 January 2025

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