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Meta-Analysis
. 2015 Nov;59(11):6696-707.
doi: 10.1128/AAC.01331-15. Epub 2015 Aug 10.

Systematic review and meta-analysis of randomized controlled trials of antibiotics and antiseptics for preventing infection in people receiving primary total hip and knee prostheses

Jeffrey Voigt  1 , Michael Mosier  2 , Rabih Darouiche  3
Affiliations
Meta-Analysis

Systematic review and meta-analysis of randomized controlled trials of antibiotics and antiseptics for preventing infection in people receiving primary total hip and knee prostheses

Jeffrey Voigt et al. Antimicrob Agents Chemother. 2015 Nov.

Abstract

Infection rates in primary (first-time) major joint arthroplasty continue to be a significant issue. The effect of antibiotic and antiseptic prophylaxis on outcomes for this type of surgery has not been adequately reviewed. A systematic search of the main databases for randomized controlled trials (RCTs) evaluating antibiotics and antiseptics was conducted to evaluate the predetermined endpoints of infection, adverse events, costs, quality of life, and concentration levels of antibiotics. A meta-analysis using pooled effect estimates and fixed-effect and random-effect models of risk ratios (RR), calculated with 95% confidence intervals (CI), was utilized. Thirty (30) RCTs examined the effects of antibiotic and antiseptic prophylaxis on infections after primary total hip arthroplasty (THA) (total of 11,597 participants) and total knee arthroplasty (TKA) (total of 6,141 participants). For THA, preoperative systemic intravenous (i.v.) antibiotic prophylaxis may be effective in reducing the incidence of infection after THA from 6 months to ≥5 years. For TKA, there is no RCT evidence that antibiotics and/or antiseptics have any effect on infection rate. Preoperative systemic antibiotic prophylaxis in primary THA may be effective at reducing infection rate. There is no evidence that timing, route of administration, or concentration levels have an effect on reducing infections, adverse events, or costs in THA or TKA. Many of the trials included in this study were published in the 1980s and 1990s. Thus, it would be important to replicate a number of them based on current patient demographics and incidence of bacterial resistance.

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Figures

FIG 1
FIG 1
PRISMA flow diagram.
FIG 2
FIG 2
Risk of bias summary.
FIG 3
FIG 3
Risk of bias graph.
FIG 4
FIG 4
Forest plot THA. Infection at 6 months.
FIG 5
FIG 5
Forest plot THA. Infection at 2.5 years.
FIG 6
FIG 6
Forest plot THA. Infection at ≥5 years.
FIG 7
FIG 7
Forest plot THA: systemic antibiotic versus antibiotic cement. Infection at 2 years.
FIG 8
FIG 8
Forest plot THA: i.v. systemic cephalosporin versus glycopeptide. Infection at 2 years.
FIG 9
FIG 9
Forest plot TKA. Infection rate for one antibiotic versus that of another.
FIG 10
FIG 10
Forest plot THA. Adverse events: repeat or revision surgery.
See this image and copyright information in PMC

References

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    1. Agency for Healthcare Research and Quality. 2015. HCUPNet 2012 inpatient database: ICD9CMD procedure codes 81.51 (THA) and 81.54 (TKA). http://hcupnet.ahrq.gov/ Accessed on 27 April 2015.
    1. Maradit-Kremers H, Crowson CS, Larson D, Jiranek WA, Berry DJ. 2014. Prevalence of total hip (THA) and total knee (TKA) arthroplasty in the United States. Abstr 2014 Am Assoc Orthop Surg, abstr P057.
    1. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. 1998. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 27:1247–1254. doi:10.1086/514991. - DOI - PubMed
    1. Hanssen AD, Rand JA. 1998. Evaluation and treatment of infection at the site of total hip or knee arthroplasty. J Bone Joint Surgery Am 80:910–922.

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