Prevention of prosthetic joint and other types of orthopedic hardware infection
- Elie Berbari, MD, FIDSA
Elie Berbari, MD, FIDSA
- Professor of Medicine
- Mayo Clinic College of Medicine
- Larry M Baddour, MD, FIDSA, FAHA
Larry M Baddour, MD, FIDSA, FAHA
- Professor of Medicine
- Mayo Clinic College of Medicine
Management of orthopedic hardware infection (including prosthetic joint infection as well as other types of orthopedic hardware) requires multiple surgical interventions and prolonged antibiotic therapy; treatment failure is common. Given the challenges associated with treating orthopedic hardware infection, prevention of infection is clearly desirable.
Most literature regarding prevention of orthopedic hardware infection is derived from prosthetic joint infection since this is the most common type of orthopedic hardware placement. Data regarding other types of orthopedic hardware are limited; however, in general, similar principles of prevention may be applied.
Issues relating to the prevention of orthopedic hardware infection will be reviewed here; guidelines addressing these issues include the Centers for Disease Control and Prevention guideline for prevention of surgical site infection , the National Surgical Infection Prevention Project [2,3], guidelines from the Medical Letter (table 1) , guidelines from the American Society of Health-System Pharmacists , and an Advisory Statement from the American Academy of Orthopaedic Surgeons .
General principles for prevention of surgical site infection are discussed separately. (See "Overview of control measures for prevention of surgical site infection in adults".)
The epidemiology, clinical manifestations, diagnosis, and treatment of orthopedic hardware infections are discussed separately. (See "Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis" and "Prosthetic joint infection: Treatment".)
- Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017.
- Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
- Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006; 43:322.
- Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 2012; 10:73.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
- American Academy of Orthopaedic Surgeons (AAOS). Advisory Statement. Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty 2004 http://www.aaos.org/about/papers/advistmt/1027.asp (Accessed on January 09, 2012).
- Sousa R, Muñoz-Mahamud E, Quayle J, et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 2014; 59:41.
- Lamb MJ, Baillie L, Pajak D, et al. Elimination of Screening Urine Cultures Prior to Elective Joint Arthroplasty. Clin Infect Dis 2017; 64:806.
- Bailin S, Noiseux N, Pottinger JM, et al. Screening Patients Undergoing Total Hip or Knee Arthroplasty with Perioperative Urinalysis and the Effect of a Practice Change on Antimicrobial Use. Infect Control Hosp Epidemiol 2017; 38:281.
- Kapadia BH, Berg RA, Daley JA, et al. Periprosthetic joint infection. Lancet 2016; 387:386.
- Pieringer H, Stuby U, Biesenbach G. Patients with rheumatoid arthritis undergoing surgery: how should we deal with antirheumatic treatment? Semin Arthritis Rheum 2007; 36:278.
- AlBuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty: a systematic review. J Bone Joint Surg Br 2008; 90:915.
- Southwell-Keely JP, Russo RR, March L, et al. Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Clin Orthop Relat Res 2004; :179.
- Boxma H, Broekhuizen T, Patka P, Oosting H. Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet 1996; 347:1133.
- Trampuz A, Zimmerli W. Antimicrobial agents in orthopaedic surgery: Prophylaxis and treatment. Drugs 2006; 66:1089.
- Soriano A, Bori G, García-Ramiro S, et al. Timing of antibiotic prophylaxis for primary total knee arthroplasty performed during ischemia. Clin Infect Dis 2008; 46:1009.
- The diagnosis of periprosthetic joint infections of the hip and knee. Guidelines and evidence report. Adopted by the American Academy of Orthopaedic Surgeons Board of Directors, June 18, 2010.
- Gillespie WJ. Prevention and management of infection after total joint replacement. Clin Infect Dis 1997; 25:1310.
- Nelson CL, Green TG, Porter RA, Warren RD. One day versus seven days of preventive antibiotic therapy in orthopedic surgery. Clin Orthop Relat Res 1983; :258.
- Parvizi J, Saleh KJ, Ragland PS, et al. Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 2008; 79:335.
- Bourne RB. Prophylactic use of antibiotic bone cement: an emerging standard--in the affirmative. J Arthroplasty 2004; 19:69.
- Fish DN, Hoffman HM, Danziger LH. Antibiotic-impregnated cement use in U.S. hospitals. Am J Hosp Pharm 1992; 49:2469.
- Engesaeter LB, Lie SA, Espehaug B, et al. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 2003; 74:644.
- van Kasteren ME, Manniën J, Ott A, et al. Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 2007; 44:921.
- Jiranek W. Antibiotic-loaded cement in total hip replacement: current indications, efficacy, and complications. Orthopedics 2005; 28:s873.
- Hanssen AD. Prophylactic use of antibiotic bone cement: an emerging standard--in opposition. J Arthroplasty 2004; 19:73.
- Block JE, Stubbs HA. Reducing the risk of deep wound infection in primary joint arthroplasty with antibiotic bone cement. Orthopedics 2005; 28:1334.
- Cummins JS, Tomek IM, Kantor SR, et al. Cost-effectiveness of antibiotic-impregnated bone cement used in primary total hip arthroplasty. J Bone Joint Surg Am 2009; 91:634.
- Roberts DW. What is the role of antibiotic-containing cement in total knee arthroplasty? J Bone Joint Surg Am 2013; 95:e62.
- Westberg M, Frihagen F, Brun OC, et al. Effectiveness of gentamicin-containing collagen sponges for prevention of surgical site infection after hip arthroplasty: a multicenter randomized trial. Clin Infect Dis 2015; 60:1752.
- Watters W 3rd, Rethman MP, Hanson NB, et al. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. J Am Acad Orthop Surg 2013; 21:180.
- Wahl MJ. Myths of dental-induced prosthetic joint infections. Clin Infect Dis 1995; 20:1420.
- Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 2010; 50:8.
- Young H, Hirsh J, Hammerberg EM, Price CS. Dental disease and periprosthetic joint infection. J Bone Joint Surg Am 2014; 96:162.
- Skaar DD, O'Connor H, Hodges JS, Michalowicz BS. Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey. J Am Dent Assoc 2011; 142:1343.
- Eskinazi D, Rathbun W. Is systematic antimicrobial prophylaxis justified in dental patients with prosthetic joints? Oral Surg Oral Med Oral Pathol 1988; 66:430.
- Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2015; 146:11.
- Simmons NA, Ball AP, Cawson RA, et al. Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses. Lancet 1992; 339:301.
- Gupta A, Osmon DR, Hanssen AD, et al. Genitourinary Procedures as Risk Factors for Prosthetic Hip or Knee Infection: A Hospital-Based Prospective Case-Control Study. Open Forum Infect Dis 2015; 2:ofv097.
- American Urological Association, American Academy of Orthopaedic Surgeons. Antibiotic prophylaxis for urological patients with total joint replacements. J Urol 2003; 169:1796.
- ASGE STANDARDS OF PRACTICE COMMITTEE, Banerjee S, Shen B, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2008; 67:791.
- PRIOR TO HARDWARE REPLACEMENT
- S. aureus decolonization
- Other preventive measures
- DURING HARDWARE REPLACEMENT
- Antimicrobial prophylaxis
- Local antibiotic delivery
- FOLLOWING HARDWARE REPLACEMENT
- Dental procedures
- Urologic procedures
- Gastrointestinal procedures
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS