CORR Insights(®): Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA.

Abstract

D espite the best preoperative and intraoperative practices, contamination of the surgical site may be unavoidable due to airborne or skin bacteria. Prophylactic antibiotics can help inhibit or kill contaminating bacteria, thereby preventing bacterial adherence to the arthroplasty implants, biofilm formation, and infection [7]. Additionally, systemic antibiotic prophylaxis has been shown to reduce infections in orthopaedic procedures [5, 6] and is part of well-established guidelines [2]. However, optimal antibiotic selection remains unclear. Cefazolin and cefuroxime are the recommended antibiotics, unless the patient has blactam allergy, in which case clindamycin or vancomycin should be used [2]. The increasing prevalence of infections by resistant microorganisms, such as methicillin resistant Staphylococcus aureus (MRSA), has raised the question whether prophylaxis with vancomycin is necessary. No definite criteria exist, but vancomycin should be considered for patients at high risk for infection, such as patients colonized with MRSA or treated in institutions with recent MRSA outbreaks [7]. The protective effect of antibiotics depends on achieving adequate local tissue levels, but systemic administration of high doses of antibiotics may be limited by associated adverse effects. For this reason, local antibiotic delivery becomes an attractive option that could achieve high local levels while avoiding systemic toxicity. Antibiotic-impregnated cement has been widely employed in arthroplasty procedures and has been shown to reduce revisions due to infection in total hip arthroplasty [4, 5]. On the other hand, the benefit of adding antibiotics to the cement in TKA has not been conclusively demonstrated [1]. Intraosseous regional administration (IORA) of antibiotics was recently This CORR Insights is a commentary on the article ‘‘Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA’’ by Young and colleagues available at: DOI: 10.1007/s11999-015-4464-x. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at doi:10.1007/s11999-0154464-x. C. G. Zalavras MD, PhD (&) Keck School of Medicine, University of Southern California, 1200 N State Street, GNH 3900, Los Angeles, CA 90033, USA e-mail: zalavras@usc.edu CORR Insights Published online: 21 August 2015 The Association of Bone and Joint Surgeons1 2015