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

Context: There is a need to find the optimal doses and any need for weight adjustment in patients who have higher than standard BMI. There is also a need to determine if repeating doses of antibiotics is necessary when the surgery takes longer than usual.
Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 28 of 221 articles were relevant to the 2 following questions regarding perioperative antibiotic prophylaxis to prevent PJI.

Preoperative antibiotics have different pharmacokinetics based on patient weight and should be weight-adjusted. An additional dose of antibiotic should be administered intraoperatively after two half-lives of the prophylactic agent. The general guidelines for frequency of intraoperative antibiotic administration are provided. We recommend that re-dosing of antibiotics be considered in cases of large blood volume loss (> 2000 cc) and fluid resuscitation (> 2000 cc). As these are independent variables¡ re-dosing should be considered as soon as the first of these parameters are met.

Recommendations for need for weight adjustment doses and repeat of doses in longer duration surgeries in terms 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.