AI Article Synopsis

  • Extended oral antibiotic (EOA) prophylaxis has significantly reduced prosthetic joint infection rates in high-risk patients after total hip arthroplasty (THA), leading to an increase in research on its use despite the lack of national guidelines.
  • From 2010 to 2022, the use of EOA prophylaxis surged by 366% after primary THA and by 298% after revision THA, with a substantial portion of patients receiving these antibiotics for extended periods beyond seven days.
  • Trends show a growing inconsistency in EOA prescription patterns among different patient demographics, indicating a need for established guidelines to enhance antibiotic stewardship and mitigate infection risks.

Article Abstract

Background: In patients considered high-risk for infection, extended oral antibiotic (EOA) prophylaxis has been demonstrated to reduce rates of prosthetic joint infection following total hip arthroplasty (THA). Although national guidelines regarding their use have not yet been created, the increase in literature surrounding EOA prophylaxis suggests a potential change in practice patterns. The purpose of this study was to investigate the trends in utilization of EOA prophylaxis following THA from 2010 to 2022 and identify prescription patterns.

Methods: A total of 646,059 primary THA and 51,879 aseptic revision THA patients were included in this study. Patients who underwent primary or aseptic revision THA between 2010 and 2022 were identified in a national administrative claims database. Rates and duration of EOA prescriptions were calculated. A secondary analysis examined rates of utilization across demographics, including patients considered high risk for infection.

Results: From 2010 to 2022, utilization of EOA increased by 366% and 298% following primary and revision THA, respectively. Of patients prescribed postoperative antibiotics, 30% and 59% were prescribed antibiotics for more than 7 days following primary and revision THA, respectively. Rates of utilization were similar between high-risk individuals and the general population.

Conclusions: Rates of utilization of EOA prophylaxis after THA have increased significantly since 2010. As current trends demonstrate a wide variation in prescription patterns, including in length of antibiotic duration and in patient population prescribed, guidelines surrounding the use of EOA prophylaxis after THA are necessary to promote antibiotic stewardship while preventing rates of periprosthetic joint infection.

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Source
http://dx.doi.org/10.1016/j.arth.2024.01.016DOI Listing

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