Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection

November 30, 2018 at 8:28 am

Journal of Arthroplasty November 2018 V.33 N.11 P. 3551–3554

Alexander J. Rondon, Michael M. Kheir, Timothy L. Tan, Noam Shohat, Max R. Greenky, Javad Parvizi

Background

One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI.

Methods

A retrospective study of 17,393 primary total joint arthroplasties receiving cefazolin as perioperative prophylaxis from 2005 to 2017 was performed. Patients were stratified into 2 groups (underdosed and adequately dosed) based on patient weight and antibiotic dosage. Patients who developed PJI within 1 year following index procedure were identified. A bivariate and multiple logistic regression analyses were performed to control for potential confounders and identify risk factors for PJI.

Results

The majority of patients weighing greater than 120 kg (95.9%, 944/984) were underdosed. Underdosed patients had a higher rate of PJI at 1 year compared with adequately dosed patients (1.51% vs 0.86%, P = .002). Patients weighing greater than 120 kg had higher 1-year PJI rate than patients weighing less than 120 kg (3.25% vs 0.83%, P < .001). Patients who were underdosed (odds ratio, 1.665; P = .006) with greater comorbidities (odds ratio, 1.259; P < .001) were more likely to develop PJI at 1 year.

Conclusion

Cefazolin underdosing is common, especially for patients weighing more than 120 kg. Our study reports that underdosed patients were more likely to develop PJI. Orthopedic surgeons should pay attention to the weight-based dosing of antibiotics in the perioperative period to avoid increasing risk of PJI.

abstract

https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/pdf

Entry filed under: Antimicrobianos, Bacterias, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones en Obesos, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Infecciones y Obesidad, Metodos diagnosticos, REPORTS, Sepsis, Update.

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