Preoperative prophylactic antibiotics administration does not influence culture yield in revision shoulder arthroplasty

Kurt Stoll; Samuel Alfonsi 3rd; Adam Z Khan; Alayna Vaughan; Surena Namdari

doi:10.1016/j.jse.2023.05.005

Preoperative prophylactic antibiotics administration does not influence culture yield in revision shoulder arthroplasty

J Shoulder Elbow Surg. 2023 Nov;32(11):2366-2370. doi: 10.1016/j.jse.2023.05.005. Epub 2023 Jun 9.

Authors

Kurt Stoll¹, Samuel Alfonsi 3rd², Adam Z Khan³, Alayna Vaughan³, Surena Namdari³

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA. Electronic address: Kurt.e.stoll@gmail.com.
² Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
³ Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.

PMID: 37302622
DOI: 10.1016/j.jse.2023.05.005

Abstract

Background: The importance of administrating prophylactic antibiotics prior to a surgical procedure is well established. Given the difficulty in diagnosing shoulder periprosthetic infections, which are more indolent in nature, some advocate holding prophylactic antibiotics prior to obtaining cultures as there is a concern antibiotics may lead to a false negative culture result. The purpose of this study is to determine whether administration of antibiotics prior to obtaining cultures in revision shoulder arthroplasty influences culture yield.

Methods: This was a retrospective analysis of revision shoulder arthroplasty cases performed at a single institution between 2015 and 2021. During the study period, each surgeon had a standardized protocol that dictated whether antibiotics were given or held prior to each revision surgery. Each case was categorized into either a Preculture antibiotic group, if antibiotics were administered prior to incision, or a Postculture antibiotic group if antibiotics were administered after incision and obtaining cultures. The International Consensus Meeting (ICM) scoring criteria provided by the Musculoskeletal Infection Society was used to categorize the probability of periprosthetic joint infection for each case. Culture positivity was calculated as the ratio of positive cultures and total number of cultures obtained.

Results: One hundred twenty-four patients met inclusion criteria. There were 48 patients in the Preculture group and 76 patients in the Postculture group. No significant difference in patient demographics or ICM criteria (P = .09) was observed between the 2 groups. With regard to culture positivity, there was no difference between the Preculture antibiotic group and the Postculture antibiotic group (16% vs. 15%, P = .82, confidence interval = 8%-25% vs. 10%-20%, respectively).

Conclusion: In the setting of revision shoulder arthroplasty, timing of antibiotic administration did not significantly influence culture yield. This study supports the use of prophylactic antibiotics prior to obtaining cultures in revision shoulder arthroplasty.

Keywords: Prophylactic antibiotics; antibiotic timing; culture positivity; periprosthetic infection; prophylactic antibiotics; revision shoulder arthroplasty.