Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients

Ewout S Veltman, Erik Lenguerrand, Dirk Jan F Moojen, Michael R Whitehouse, Rob G H H Nelissen, Ashley W Blom, Rudolf W Poolman, Ewout S Veltman, Erik Lenguerrand, Dirk Jan F Moojen, Michael R Whitehouse, Rob G H H Nelissen, Ashley W Blom, Rudolf W Poolman

Abstract

Background and purpose - The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods - A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results - For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28-35), 39 (25-59), and 23 (15-34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24-31), 40 (24-62), and 24 (16-36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation - In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.

Trial registration: ClinicalTrials.gov NCT03348254.

Figures

Figure 1.
Figure 1.
Rate of complete revision for infection in the first 12 months following primary hip replacement by type of antibiotics regimen.
Figure 2.
Figure 2.
Rate of complete revision for infection in the first 12 months following primary knee replacement by type of antibiotics regimen.
Figure 3.
Figure 3.
Hazard ratio and 95% CI* of complete revision for infection in the first 12 months following primary hip replacement by type of antibiotics regimen (reference: cefazolin multiple dose). * Derived from unadjusted Poisson model with restricted cubic splines (3 degree of freedom) (see Appendix Table 2).
Figure 4.
Figure 4.
Hazard ratio and 95% CI* of complete revision for infection during the first 12 months following primary knee replacement by type of antibiotics regimen (reference: cefazolin multiple dose). *Derived from unadjusted Poisson model with restricted cubic splines (3 degree of freedom) (see Appendix Table 3).

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