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

Context: There is a need to find the situations that Vancomycin should be used as antibiotic prophylaxis in hip and knee arthroplasty. There are also situations that might need different antibiotic prophylaxis protocol; such as abnormal urinary screening test or indwelling urinary catheter and previous joint infection. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on periprosthetic joint infection (PJI) reviewed English literature for relevant articles. 62 of 221 articles were relevant to the six following questions regarding perioperative antibiotic prophylaxis to prevent PJI. Vancomycin should be considered for patients who are current Methicillin resistant Staphylococcus aureus (MRSA) carriers or have anaphylactic allergy to penicillins. Routine use of vancomycin for preoperative prophylaxis is not recommended. Routine prophylactic use of dual antibiotics is not recommended. The presence of urinary tract symptoms should trigger urinary screening prior to total joint arthroplasty (TJA). Asymptomatic patients with bacteriuria may safely undergo TJA provided that routine prophylactic antibiotics are administered. Patients with acute urinary tract infections (UTI) need to be treated prior to elective arthroplasty. The type of preoperative antibiotic administered to a patient with prior septic arthritis or PJI should cover the previous infecting organism of the same joint. In these patients, we recommend the use of antibiotic-impregnated cement, if a cemented component is utilized. There is no evidence to support the continued use of postoperative antibiotics when urinary catheter or surgical drains are in place. Urinary catheters and surgical drains should be removed as soon as safely possible. 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.