Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: A Retrospective Cohort Study

Abstract

Background: Perioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. Objective: To investigate the infection rate after total knee arthroplasty (TKA) compared between the standard course, which is 24 hours or less and the extended course, which is more than 24 hours of perioperative antibiotic prophylaxis in a developing country. Materials and Methods: The present was a retrospective study that included patients who underwent unicompartmental knee arthroplasty or TKA between January 2013 and December 2018. Three thousand three hundred and sixteen patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between the groups. The factors significantly associated with PJI were also analyzed. Results: PJI developed in 0.5% (6/1,284 patients) of the standard course group, and in 1.2% (24/2,032 patients) of the extended course group. The difference and 95% confidence interval for the difference between groups were –0.71% (–1.34 to –0.04), which confirmed the non-inferiority status of the standard course group compared to the extended course group. Longer hospital length of stay significantly associated with higher infection rate (p<0.001). Postoperative wound infection was not found to be associated with age, body mass index, American Society of Anesthesiologists classification, blood transfusion, or surgery type. Conclusion: Twenty-four hours of perioperative antibiotic prophylaxis was found to be adequate for PJI prevention in a developing country setting. Keywords: Infection rate; Total knee arthroplasty; Standard course; Extended course; Perioperative antibiotic prophylaxis