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<p>This review from the Medical University of Innsbruck addresses the rational use of antibiotics in orthopedic surgery, from perioperative prophylaxis to the treatment of established infections.</p><p>Perioperative antibiotic prophylaxis follows four core principles: the right agent, correct timing (30–60 min before incision), adequate dosing and short duration. Cefazolin is the agent of choice; the historically cited 10% cross-reactivity between penicillins and cephalosporins is no longer supported by current evidence. Prophylaxis is generally unnecessary for minor arthroscopic procedures, recommended as a&#xa0;single shot for intermediate surgery, such as cruciate ligament reconstruction and mandatory for major procedures including arthroplasty.</p><p>In periprosthetic joint infections (PJI), the therapeutic strategy is guided by the time of the infection, pathogen profile and implant stability. Debridement, antimicrobial therapy and implant retention (DAIR) is indicated for acute infections with short symptom duration (success rate 60–65%), the 1‑stage exchange is gaining ground in selected patients and 2‑stage exchange remains the gold standard for chronic infections. Rifampicin is an essential combination partner in staphylococcal biofilm-associated infections but must never be used as monotherapy. The OVIVA trial confirmed that oral therapy is non-inferior to intravenous treatment when appropriate agents are chosen. A&#xa0;12-week treatment duration is the standard benchmark, with reduction to 6–8&#xa0;weeks feasible in selected cases.</p><p>Multidrug-resistant organisms, particularly methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), pose a&#xa0;growing challenge. Clinical outcomes are determined less by methicillin resistance than by resistance to rifampicin or fluoroquinolones. Structured antimicrobial stewardship programmes demonstrably reduce resistance rates, adverse effects and costs. Emerging agents such as long acting lipoglycopeptides and bacteriophage therapy promise to expand treatment options for difficult to treat infections.</p>

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Antibiotikagabe bei orthopädischen Operationen

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月16日

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  • Alexa Schaufler,
  • Wolfram Mayr,
  • Gernot Fritsche,
  • Felix Riechelmann,
  • Wolfgang Hackl

摘要

This review from the Medical University of Innsbruck addresses the rational use of antibiotics in orthopedic surgery, from perioperative prophylaxis to the treatment of established infections.

Perioperative antibiotic prophylaxis follows four core principles: the right agent, correct timing (30–60 min before incision), adequate dosing and short duration. Cefazolin is the agent of choice; the historically cited 10% cross-reactivity between penicillins and cephalosporins is no longer supported by current evidence. Prophylaxis is generally unnecessary for minor arthroscopic procedures, recommended as a single shot for intermediate surgery, such as cruciate ligament reconstruction and mandatory for major procedures including arthroplasty.

In periprosthetic joint infections (PJI), the therapeutic strategy is guided by the time of the infection, pathogen profile and implant stability. Debridement, antimicrobial therapy and implant retention (DAIR) is indicated for acute infections with short symptom duration (success rate 60–65%), the 1‑stage exchange is gaining ground in selected patients and 2‑stage exchange remains the gold standard for chronic infections. Rifampicin is an essential combination partner in staphylococcal biofilm-associated infections but must never be used as monotherapy. The OVIVA trial confirmed that oral therapy is non-inferior to intravenous treatment when appropriate agents are chosen. A 12-week treatment duration is the standard benchmark, with reduction to 6–8 weeks feasible in selected cases.

Multidrug-resistant organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA), pose a growing challenge. Clinical outcomes are determined less by methicillin resistance than by resistance to rifampicin or fluoroquinolones. Structured antimicrobial stewardship programmes demonstrably reduce resistance rates, adverse effects and costs. Emerging agents such as long acting lipoglycopeptides and bacteriophage therapy promise to expand treatment options for difficult to treat infections.