National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK
Aims: Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-10-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.410.BJO-2023-0055.R1 |
| _version_ | 1797648116372996096 |
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| author | Ahmed Mabrouk Alexander Abouharb Gabriel Stewart Jeya Palan Hemant Pandit |
| author_facet | Ahmed Mabrouk Alexander Abouharb Gabriel Stewart Jeya Palan Hemant Pandit |
| author_sort | Ahmed Mabrouk |
| collection | DOAJ |
| description | Aims: Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. Methods: The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital’s website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance. Results: The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no Staphylococcus coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no Enterococcus coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance. Conclusion: This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended. Cite this article: Bone Jt Open 2023;4(10):742–749. |
| first_indexed | 2024-03-11T15:26:33Z |
| format | Article |
| id | doaj.art-bdc7534b7af2444abe487480e7045f01 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-11T15:26:33Z |
| publishDate | 2023-10-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-bdc7534b7af2444abe487480e7045f012023-10-27T13:27:29ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622023-10-0141074274910.1302/2633-1462.410.BJO-2023-0055.R1National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UKAhmed Mabrouk0https://orcid.org/0000-0002-2547-3176Alexander Abouharb1https://orcid.org/0000-0003-2211-9064Gabriel Stewart2Jeya Palan3https://orcid.org/0000-0002-9859-274XHemant Pandit4https://orcid.org/0000-0001-7392-8561Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UKLeeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UKLeeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UKLeeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UKLeeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UKAims: Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. Methods: The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital’s website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance. Results: The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no Staphylococcus coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no Enterococcus coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance. Conclusion: This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended. Cite this article: Bone Jt Open 2023;4(10):742–749.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.410.BJO-2023-0055.R1surgical site infectionsantibioticsclinical guidelinesbest practiceprophylactic antibiotic(s)antibiotic(s)gentamicincefuroximeprophylaxisprimary arthroplastysurgical site infection (ssi)antibiotic prophylaxisorthopaedic procedurescephalosporins |
| spellingShingle | Ahmed Mabrouk Alexander Abouharb Gabriel Stewart Jeya Palan Hemant Pandit National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK Bone & Joint Open surgical site infections antibiotics clinical guidelines best practice prophylactic antibiotic(s) antibiotic(s) gentamicin cefuroxime prophylaxis primary arthroplasty surgical site infection (ssi) antibiotic prophylaxis orthopaedic procedures cephalosporins |
| title | National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK |
| title_full | National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK |
| title_fullStr | National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK |
| title_full_unstemmed | National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK |
| title_short | National variation in prophylactic antibiotic use for elective primary total joint replacement: an analysis of guidelines across hospitals and trusts in the UK |
| title_sort | national variation in prophylactic antibiotic use for elective primary total joint replacement an analysis of guidelines across hospitals and trusts in the uk |
| topic | surgical site infections antibiotics clinical guidelines best practice prophylactic antibiotic(s) antibiotic(s) gentamicin cefuroxime prophylaxis primary arthroplasty surgical site infection (ssi) antibiotic prophylaxis orthopaedic procedures cephalosporins |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.410.BJO-2023-0055.R1 |
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