Antibiotic Prophylaxis in High-Risk Arthroplasty Patients

Overview

About this study

The primary aims of this study are to determine whether extended oral prophylactic antibiotics after primary total joint arthropasty (TJA) decreases the incidence of periprosthetic joint infection (PJI) in a high-risk patient population, and to determine whether extended oral prophylactic antibiotics after primary TJA decreases the incidence of surgical wound complications in a high-risk patient population.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

Patient ≥ 18 years of age.
Patient is a candidate for elective, primary total hip arthroplasties (THA) or total knee arthroplasties (TKA).
Patient is considered high-risk for developing Periprosthetic joint infections (PJI) based on having at least one of the following criteria:
- Body mass index (BMI) > 35 kg/m^2;
- Diagnosis of diabetes mellitus;
- Active tobacco smoker;
- Chronic kidney disease;
- Autoimmune disease;
- Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-sensitive Staphylococcus aureus (MSSA).

Exclusion Criteria:

< 18 years of age.
Inability to consume oral antibiotics.
Allergy to antibiotic alternatives in the protocol.
History of clostridium difficile colitis.
Revision hip or knee arthroplasty procedure.
Non-elective surgery.
Hemiarthroplasty.
Unicompartmental knee arthroplasty.
Simultaneous bilateral THA or TKA.
Will have subsequent THA or TKA within 12 weeks of the index study procedure.
Pregnant.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location	Status	Contact
Rochester, Minn. Mayo Clinic principal investigator Nicholas Bedard, M.D.	Open for enrollment	Contact information: Peter Brennan (507) 284-4430 Brennan.Peter@mayo.edu

Mayo Clinic Location

Status

Contact

Rochester, Minn.

Mayo Clinic principal investigator

Nicholas Bedard, M.D.

Open for enrollment

Contact information:

Peter Brennan

(507) 284-4430

Brennan.Peter@mayo.edu

More information

Publications

Total joint arthroplasty (TJA) episodic payment models shift risk and cost of periprosthetic joint infection (PJI) to surgeons and hospitals, causing some to avoid treating high-risk patients. Furthermore, there are little data to support optimization of host factors preoperatively to decrease PJI, and recent literature supports using extended antibiotic prophylaxis following reimplantation TJA. The purpose of this study was to evaluate whether extended oral antibiotic prophylaxis minimized PJI after primary TJA in high-risk patients. Read More on PubMed
There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic-resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non-drug approaches to reduce bacteria functions related to orthopedic implant-associated infections. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:22-32, 2018. Read More on PubMed
This study characterizes the patient and clinical factors influencing the economic burden of periprosthetic joint infection (PJI) in the United States. The 2001-2009 Nationwide Inpatient Sample was used to identify total hip and knee arthroplasties using International Classification of Diseases, Ninth Revision, procedure codes. The relative incidence of PJI ranged between 2.0% and 2.4% of total hip arthroplasties and total knee arthroplasties and increased over time. The mean cost to treat hip PJIs was $5965 greater than the mean cost for knee PJIs. The annual cost of infected revisions to US hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. As the demand for joint arthroplasty is expected to increase substantially over the coming decade, so too will the economic burden of prosthetic infections. Read More on PubMed

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