Yoo Charlie, Meneghini R Michael
Indiana University School of Medicine - Department of Orthopedics, 550 N. University Blvd, Indianapolis, IN, 46202, USA.
Indiana Joint Replacement Institute, 14065 Borgwarner Dr, Noblesville, IN, 46060, USA.
J Clin Orthop Trauma. 2025 Apr 8;66:103011. doi: 10.1016/j.jcot.2025.103011. eCollection 2025 Jul.
Periprosthetic joint infections (PJI) are a significant healthcare and economic burden after joint replacement surgery. Extended oral antibiotic prophylaxis (EOAP) has been highlighted as a safe, efficacious, and cost-effective measure to mitigate the risk of infection against the increasing demands for total joint arthroplasty (TJA). Several studies have demonstrated substantial reductions in PJI rates, particularly among high-risk populations receiving a 7-day course of antibiotics, mainly with use of cefadroxil. Conversely, other studies have found no significant differences or even increased infection rates, highlighting concerns over antimicrobial resistance, Clostridium difficile infections (CDI), and other antibiotic-related adverse events. Additionally, recent trends show a substantial rise in EOAP utilization across the United States, demonstrating need for clear and evidence-based guidelines. There is a need for high quality randomized controlled trials to help identify optimal patient selection criteria, antibiotic type, and duration to effectively balance the benefits of EOAP against potential risks. Although there is limited evidence of significant antibiotic associated complications with the use of EOAP, care should be utilized prior to widespread adoption with antibiotic stewardship in mind.
人工关节周围感染（PJI）是关节置换手术后的一项重大医疗和经济负担。延长口服抗生素预防（EOAP）已被视为一种安全、有效且具有成本效益的措施，可应对全关节置换术（TJA）需求增加的情况下降低感染风险。多项研究表明，PJI发生率大幅降低，尤其是在接受为期7天抗生素疗程的高危人群中，主要使用的是头孢羟氨苄。相反，其他研究未发现显著差异，甚至发现感染率有所上升，这凸显了对抗菌素耐药性、艰难梭菌感染（CDI）及其他抗生素相关不良事件的担忧。此外，近期趋势显示美国各地EOAP的使用大幅增加，这表明需要明确且基于证据的指南。需要高质量的随机对照试验来帮助确定最佳的患者选择标准、抗生素类型和疗程，以有效平衡EOAP的益处与潜在风险。尽管使用EOAP导致显著抗生素相关并发症的证据有限，但在广泛采用之前应谨慎考虑抗生素管理。
