Perioperative Abx Overview Includes preoperative and postoperative antibiotics 25-50% of all antibiotics used are for prophylaxis Indications routine adminstration of prophylactic antibiotics is accepted in patients who will have a foreign body implanted bone grafting procedures large dissection resulting in significant dead space or hematoma expecting significant blood loss orthopaedics procedures that do not require prophylactic antibiotics carpal tunnel surgery diagnostic arthroscopy is more controversial Most likely pathogens to cause infection in orthopaedic procedures includes S aureus S epidermidis aerobic streptococci anaerobic cocci Perioperative Prophylaxis in Total Joint Replacement (AAOS Recommendations) Choice of antibiotics if no beta-lactam allergy cefazolin or cefuroxime if beta-lactam allergy vancomycin or clindamycin if history of MRSA infection or in areas with high prevelance of MRSA vancomycin in addition to cefazolin use judiciously - increased risk of vancomycin-resistant enterococcus (VRE) Administration always administer abx prior to tourniquet inflation cefazolin administer within 1 hour of incision double amount of cefazolin administered if above 80kg vancomycin administer within 2 hours of incision Duration prophylactic antibiotics should NOT exceed 24 hours after surgery In clean and clean-contaminated procedures, do not administer additional doses of antibiotics after incision is closed in the operating room, even in the presence of a drain. Dental Procedure Abx Prophylaxis in TJR Patients (AAOS & ADA) Indications TJA patients at increased risk of hematogenous seeding should be given prophylactic antibiotics prior to dental procedures. This includes all patients for the first two years after TJA immunocompromised patients drug induced immunosuppression radiation induced immunosuppression inflammatory arthropathies including SLE and RA comorbidities including previous prosthetic joint infection Type I (insulin-dependent) diabetes malnourishment hemophilia HIV malignancy evidence to support recommendations AAOS and ADA recognizes there is limited or inconclusive evidence to support the recommendations above and practitioners should use clinical judgment Administration antibiotics is given 1 hour before dental procedure patients NOT allergic to penicillin should be given amoxicillin or cephalexin 2 grams orally if unable to take oral medications than 1 gram cefazolin or 2 gram ampicillin IV or IM if allergic to penicillin clindamycin 600 mg orally if unable to take oral medications than clindamycin 600 mg IV Splenectomy Patients Prophylaxis Indications in splenectomized patients pneumococcal immunization indicated in all splenectomized patients and those with functional hyposplenism haemophilus influenza type B vaccine indicated in all patients not previously immunized meningococcal group C conjugate vaccine indicated in all patients not previously immunized influenza immunization should be given annually lifelong prophylactic antibiotics (oral phenoxymethylpenicillin or erythromycin) indicated in all splenectomized patients