The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

摘要

In order to adequately diagnose and treat infections, it is of utmost importance that reliable cultures be obtained without prior use of antimicrobial therapy, because it may interfere with bacterial growth (1). This principle is even more crucial in patients with a prosthetic implant in situ that needs to be revised (2, 3). Misdiagnosis in this subgroup of patients may lead to unnecessary and invasive re-revision surgeries. These surgeries are accompanied not only by high health care costs due to longer hospital admissions and rehabilitation periods but also by a high patient mortality (4–6). In approximately 10 to 20% of patients with an aseptic loosening, an infection that was not known preoperatively is diagnosed during revision arthroplasty (7–9). This is partly explained by false-negative cultures due to prior antibiotic therapy (10–12). Subsequently, it has been advocated that preoperative antimicrobial prophylaxis should be withheld in this patient category until intraoperative tissue samples for culture are obtained. However, the importance of timely administration of preoperative antimicrobial prophylaxis to prevent surgical site infections is well known (13–17). This is particularly important in those patients undergoing revision surgery in whom infection is not suspected. Although extensive studies have shown that prolonged use of antimicrobial therapy before surgery results in false-negative intraoperative cultures, the influence of a single dose of antibiotics prior to surgery on culture yield is less clear (3). Since the protection of the new prosthetic implant for infection is critical, clarification on this topic is essential. We therefore performed a systematic review to evaluate if culture yield is affected by preoperative antimicrobial prophylaxis in revision arthroplasties.