1477. Association Between Surgical Antimicrobial Prophylaxis Regimen and Risk of Periprosthetic Joint Infection Following Total Hip and Knee Arthroplasty
Session: Poster Abstract Session: HAI: Surgical Site Infections
Friday, October 28, 2016
Room: Poster Hall

Background: Approximately 320,000 total hip replacements and 640,000 total knee replacements occur each year in the United States. There are few studies comparing the effectiveness of surgical antimicrobial prophylaxis (AMP) regimens. We examined the risk of periprosthetic joint infection (PJI) following total hip and knee arthroplasty by type of AMP regimen.

Methods: We identified all adult patients captured in the Truven Health Analytics MarketScan® Hospital Drug Database who had total hip or knee replacement surgery performed from 2007-2010 without a prior replacement surgery in the previous 12 months.  Patients who had ICD-9-CM codes indicating PJI (996.66) or post-operative infection (998.51, 998.59) recorded within 12 months post-arthroplasty at a readmission to the same hospital were considered to have a surgical site infection of interest. Risk of PJI was determined for three AMP regimens: 1stor 2nd generation cephalosporin alone (standard AMP), vancomycin alone, and vancomycin plus standard AMP (extended AMP).  A multivariate logistic regression model was used to estimate the relative risk of PJI for each AMP regimen.

Results: Among 451 hospitals, 181,516 eligible hip and knee arthroplasty procedures were identified, of which 2,679 cases (1.5%) had a PJI.  Of patients who received standard AMP, PJI was identified in 2,170 (1.4 %); of patients receiving vancomycin alone or extended AMP, PJI was identified in 285 (1.9 %), 224 (1.5 %), respectively.  In a multivariate model controlling for demographics, patient clinical characteristics during the index visit, and facility characteristics, the risk of PJI for those receiving vancomycin alone was higher compared to standard AMP (RR=1.31, 95% CI 1.2-1.5). The risk of PJI for those receiving expanded AMP were not significantly different compared to standard AMP (RR=1.1, 95% CI 0.95-1.3).

Conclusion: Administering vancomycin as a sole agent for antimicrobial prophylaxis may not be as effective in preventing periprosthetic joint infections following total hip and knee arthroplasties compared to standard AMP. We detected no benefit associated with adding vancomycin to standard AMP regimens for hip and knee arthroplasty.

Cheri Grigg, DVM, MPH, James Baggs, PhD, Rachel Slayton, PhD, MPH and John Jernigan, MD, MS, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA


C. Grigg, None

J. Baggs, None

R. Slayton, None

J. Jernigan, None

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