Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: a Retrospective Cohort Study

Background: Perioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. The aim of this study was to investigate the infection rate after TKA compared between standard course (≤24 hours) and extended course (>24 hours) of perioperative antibiotic prophylaxis in a developing country. Methods: This retrospective study included patients who underwent unicompartmental knee arthroplasty or total knee arthroplasty during January 2013 to December 2018. A total of 3,316 patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between groups, and we also analyzed for factors significantly associated with PJI. Results: PJI developed in 0.5% (6/1,284) of the standard course group, and in 1.2% (24/2,032) of the extended course group. The difference and 95% confidence interval for the difference between groups was -0.714% (-1.338% to -0.043%), which confirms the noninferiority status of the standard course group compared to the extended course group. Longer hospital length of stay significantly associated with higher infection rate (p=0.000). Postoperative wound infection was not found to be associated with age, body mass index, American Society of Anesthesiologists classification, blood transfusion, or surgery type. Conclusion: Twenty-four hours of perioperative antibiotic prophylaxis was found to be adequate for PJI prevention in a developing country setting. Trial registration Ethical approval and consent to participate: The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 847/2559(EC3)]