Antibiotic Resistance in Total Joint Arthroplasty: Does the Addition of Local Antibiotics Impact the Incidence of Antibiotic Resistant Infections? A Systematic Review with a Dissection of the Lower Limb.

Authors:
milli datta

Body of Abstract:
BACKGROUND

Antibiotic resistance is a key, ongoing global health issue which challenges medicine. There is concern that the current gold-standard of care to prevent postoperative infection, systemic intravenous antibiotic prophylaxis, may promote antibiotic resistance. Localised administrations, antibiotic-loaded bone cement (ALBC) or vancomycin powder (VP), have been suggested to induce less antibiotic resistance than systemic prophylaxis alone.

AIMS

This systematic review aimed to establish whether the addition of VP or ALBC, to routine systemic prophylaxis, impacts the rate of antibiotic-resistant infections after total knee or hip arthroplasty procedures, using evidence from the literature.

METHODS

Two independent PICO searches were conducted of PubMed, EMBASE, and Cochrane Library and papers matching inclusion criteria accepted. Data on prosthetic joint infections was extracted and assessed via independent, two-tailed t-tests for statistical significance. A prosection of the lower limb was produced to display structures relevant to the systematic review and serve as an educational resource for students.

RESULTS

22 articles were eligible for data analysis. No significant difference was found between the rates of resistant infections when ALBC or VP were added to systemic antibiotic prophylaxis. Notably lower proportions of resistant infections were observed in cohorts where VP was administered. This is concurrent with the low rates of vancomycin resistance documented in previous literature.

CONCLUSION

Results suggest that the incidence of antibiotic resistance is not altered by the addition of locally administered antibiotics to systemic prophylaxis, in total joint arthroplasties. However, this review was limited by the small cohorts of postoperative infections provided by the literature. Findings demonstrate need for further experimental research in this field, specifically randomised controlled trials, to combat the ongoing antibiotic resistance crisis.