Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection: Literature Review and World Consensus (Part Two)

Context: There is a need to find the best choice of preop antibiotic prophylaxis to prevent Periprosthetic Joint Infection (PJI) in the situations where the first generation cephalosporins are not indicated. Evidence Acquisition: Delegates in Workgroup 3 of the Consensus Meeting on PJI reviewed the English literature for relevant articles. Totally, 51 of 221 articles were relevant to the five following questions regarding perioperative antibiotic prophylaxis to prevent PJI. The choice of antibiotics for patients with preexisting prostheses, such as heart valves, is similar to that for routine elective arthroplasty. Currently, teicoplanin and vancomycin are reasonable alternatives when routine antibiotic prophylaxis cannot be administered. In a patient with a known anaphylactic reaction to penicillin, vancomycin or clindamycin should be administered as prophylaxis. Teicoplanin is an option only in countries where it is available. In a patient with a reported non-anaphylactic reaction to penicillin, a second generation cephalosporin can be used safely, as there is limited cross-reactivity. Penicillin skin testing may be helpful in certain situations to clarify whether the patient has a true penicillin allergy. Recommendations for choice of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.