Antibiotics Prophylaxis for Knee Arthroplasty: Benefits Versus Problems-Juniper-Publishers

Juniper Online Journal of Orthopedic & Orthoplastic Surgery




Post-operative infection of the implant is one of serious complications of knee arthroplasty and may lead the removal of the implant to eradicate the infection. The most common causative agents are reported to be Gram positive such as Staphylococcus aureus and Staphylococcus epidermidis [1] and less commonly Streptococci but Gram negative bacterial infection by Escherichia coli, Pseudomonas and Proteus are also frequently reported [2].

The discrepancy started with the demonstration of increase in the frequency of infections in the perioperative antibiotics administered group when compared to controls [3], the demonstration of effectiveness of antibiotic administration before exposure and leading to decrease in the infection frequency [4] but at the same time an alarming increase in the incidence of antibiotic resistant bacterial infections in the hospital setting [5].

Thus, the administration of prophylactic antibiotics may be a boon for one patient at the risk of bane for all the population. A serious consideration should be given to the selection of an appropriate antibiotic in appropriate dosage and for an appropriate period of time. The choice is difficult because of the number of factors that should be considered such as spectrum (it should cover common causative agents), Pharmacodynamic and Pharmacokinetic (Minimum inhibitory concentration, halflife and dosage) [6]. In the very beginning, penicillin's were used but due to wide spread development of penicillin resistance and evolution of MRSA led to the replacement of penicillin's by cephalosporins which are currently used according to AAOS guidelines [6,7]. The development of antibiotic resistance is considered and vancomycin and clindamycin can be added to the regimen in areas where antibiotic resistance is common or if the patient is allergic to Beta-lactam antibiotics. There is evidence of development of resistance against vancomycin in strains of Staphylococci and enterococci, few of the most common causative agents of infection after arthroscopy. If the regimen of prophylactic antibodies is not properly regulated we will be soon reaching a blind end with no antibiotic effective against the infection [6,7].

The antibiotic resistance is geographically distributed, different in different regions of the world [6]. The selection of prophylactic antibiotic should be based on recent literature while considering antibiotic resistance and patient allergy. Thus, collaboration between the local infection control authorities and the surgery department should be established to define an appropriate prophylactic antibiotic regimen to ensure maximum benefits and minimum risks for the technique [6].
This is important that more elaborative studies are carried in this regard and clinical trials should be encouraged to have better analysis of the outcomes. Also, infectious diseases experts and orthopedic surgeons should go along well to address the condition. Thorough registry of the resistant strains of the population should be noted and the antibiotic regimens should be improvised accordingly. Although, it requires more work than normal but that would be an ideal approach in weighing the application of the antibiotics versus not administering them.

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