Single noninferior to multiple antibiotic doses for periprosthetic joint infection prevention

In patients undergoing primary total hip arthroplasty (THA) for osteoarthritis, a single dose of antibiotic is as good as multiple doses in terms of preventing the risk of developing periprosthetic joint infection, according to a target trial emulation.

Researchers used data from the Danish National Patient Registry, Danish Hip Arthroplasty Register, and Danish Microbiology Database. The analysis included all hospitals performing THA in Denmark, and a total of 76,126 patients (mean age 68.8 years, 55.9 percent female) who underwent primary THA for osteoarthritis.

The primary outcome of periprosthetic joint infection within 90 days was defined as microbiologically confirmed infection or a clinical diagnosis recorded at revision surgery. Secondary outcomes included any revision, hospital-treated infection, community-based antibiotic use, mortality, and periprosthetic joint infection within 90 and 365 days.

Of the patients, 6,409 received single-dose and 69,717 received multiple-dose antibiotic prophylaxis. The 90-day periprosthetic joint infection rates were 0.98 percent in the single-dose group and 0.94 percent in the multiple-dose group. In weighted analyses, the prespecified noninferiority criterion, with an odds ratio of 0.97 (95 percent confidence interval, 0.73–1.29).

Results were consistent for periprosthetic joint infection rates at 90 and 365 days and across secondary outcomes.

While the findings warrant confirmation in randomized clinical trials, the study supports efforts to minimize perioperative antibiotic use.