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Comment & Response
August 28, 2019

Ideal Total Joint Arthroplasty Antibiotic Prophylaxis Unknown—Reply

Author Affiliations
  • 1Section of Infectious Diseases, Department of Medicine, Virginia Boston Healthcare System, West Roxbury, Massachusetts
  • 2VA Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
  • 3Harvard Medical School, Boston, Massachusetts
  • 4Boston University School of Medicine, Boston, Massachusetts
JAMA Surg. 2019;154(12):1169. doi:10.1001/jamasurg.2019.2908

In Reply We appreciate the insights from Lipof et al about prosthetic joint infection prevention. The authors express concern that our findings may not extrapolate well to general orthopedic patients undergoing total joint replacement (TJR). Fortunately, many previous studies, including randomized clinical trials, similarly found that extended prophylaxis regimens do not reduce surgical site infections (SSI).1 The TJRs were covered by the Surgical Care Improvement Project, which included early discontinuation of antimicrobials as a core measure; high rates of compliance with Surgical Care Improvement Project infection metrics are associated with SSI reductions, providing additional support to the notion that longer durations of prophylaxis do not improve infectious outcomes.2 In our TJR cohort (n = 38 675), risk of SSI was increased in patients who received extended regimens, rising from 1.3% after less than 24 hours to 2.7% after 48 to 72 hours.3 Because of the direction of this trend, it is highly unlikely that these findings would reverse if more or lower-risk patients were included.

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