Antibiotic Prophylaxis Protocols in 2021

Prosthetic joint implantation improves the quality of life of patients with severe osteoarthritis. However, periprosthetic joint infection (PJI) is a feared complication. The incidence of PJI after a primary arthroplasty of the hip or knee is 0.5–1.0%. The incidence of a PJI after revision arthroplasty is even worse, between 3.0% and 6.0%. PJI results from local contamination or hematogenic spread (bacteremia) of microorganisms. Local contamination occurs during surgery or in the early postoperative phase if the wound has not healed. The causative micro-organisms are therefore usually skin flora, which are Gram-positive bacteria like Staphylococcus spp. and Cutibacterium spp. Gram-negative bacilli can also cause PJI, especially in the case of a prosthesis of the lower extremity. This is due to the proximity of these joints to the groin, which is heavily colonized with Pseudomonas spp. and Enterobacterales (i.e., Escherichia coli, Klebsiella spp., Serratia spp.).