Antibiotics and antiseptics for preventing infection in people receiving revision total hip and knee prostheses: a systematic review of randomized controlled trialsReport as inadecuate




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BMC Infectious Diseases

, 16:749

Bacterial and fungal diseases

Abstract

BackgroundInfection rates in revision second and subsequent major joint arthroplasty continues to be a significant issue with rates 2–3 times those of primary procedures. The effect of antibiotic and antiseptic prophylaxis on outcomes for this type of surgery has not been adequately reviewed.

MethodsA systematic search of the main databases for randomized controlled trials RCTs evaluating antibiotics and antiseptics was conducted to evaluate the predetermined endpoints of infection.

ResultsThere were five 5 RCTs identified that examined the effects of antibiotic and antiseptic prophylaxis on infections after revision total hip arthroplasty THA total of 304 participants and total knee arthroplasty TKA total of 206 participants. For TKA, preoperative systemic intravenous IV antibiotic prophylaxis plus antibiotic cement may be effective in reducing the incidence of infection in revision TKA at 8+ years. These results however should be interpreted with caution due to the significant biases. For revision THA, there is no RCT evidence that antibiotics-antiseptics have any effect on the infection rate.

ConclusionsThere is a lack of high quality data demonstrating an effect of antibiotics or antiseptics on infection rates in revision THA-TKA. Considering the rate of infections in revisions is 2-3X that of primary procedures and; there is a consensus recommendation to use similar antibiotic and antiseptic regimens in both primary and revision procedures, there is a need for high quality studies in revision THA-TKA.

AbbreviationsC. diffClostridium difficile

CENTRALCochrane Central Register of Controlled Trials

CONSORTConsolidated Standards of Reporting Trials

FDAFood and Drug Administration

MRSAMethicillin-resistant Staphylococcus aureus

NDLTDNetwork Digital Library of Theses and Dissertations

PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses

RCTRandomized controlled trial

SSISurgical Site Infection

THATotal hip arthroplasty

TKATotal knee arthroplasty

Electronic supplementary materialThe online version of this article doi:10.1186-s12879-016-2063-4 contains supplementary material, which is available to authorized users.

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Author: Jeffrey Voigt - Michael Mosier - Rabih Darouiche

Source: https://link.springer.com/



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