Intraoperative bacterial contamination and activity of different antimicrobial prophylaxis regimens in primary knee and hip replacement

Alba Rivera, Alba Sánchez, Sonia Luque, Isabel Mur, Lluís Puig, Xavier Crusi, José Carlos González, Luisa Sorlí, Aránzazu González, Juan Pablo Horcajada, Ferran Navarro, Natividad Benito*

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthro-plasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined.

Original languageAmerican English
Article number18
Pages (from-to)1-14
Number of pages14
Issue number1
Publication statusPublished - 1 Jan 2021


  • Antibiotic levels
  • Hip arthroplasty
  • Intraoperative cultures
  • Knee arthroplasty
  • Prosthetic joint infection
  • Prosthetic joint infection prevention
  • Serum bactericidal titer
  • Surgical antimicrobial prophylaxis
  • Surgical site infection prevention


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