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Large Joints Feature

Vancomycin / Source: Wikimedia Commons, Ben Mills and Shannon Moore

Prophylactic Antibiotics in Knee Arthroscopy…Perhaps Not

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, January 10th, 2017

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Antibiotics…to give or not to give? Maybe not, says recent work from Kaiser-Permanente. The researchers, including Ronald Wyatt, M.D., an orthopedic surgeon with that institution, found no association between preoperative antibiotics and postoperative deep or superficial infection in simple knee arthroscopy.

Dr. Wyatt told OTW, “I was part of a work group of Northern California Kaiser-Permanente orthopedic surgeons that was redesigning our perioperative order set for knee arthroscopy. When it came to preoperative antibiotics there was a lively discussion. Many surgeons said they always used preoperative antibiotics, and others, including myself, never used them. I started looking into the data, and found that the studies that had been performed did not seem to have a sufficient number of patients to support their conclusions. Another reference I found showed that most orthopedic surgeons gave antibiotics because of medical-legal concerns, not necessarily because they felt they were effective in reducing postoperative infections. So I felt that Kaiser-Permanente, with our large databases and relatively stable patient population, would be an ideal venue for this study.”

“In my training I had been taught, ‘Above all, do no harm.’ So I found it interesting that antibiotics were being given that had the potential for patient harm (allergic reaction, c. difficile, drug administration error, bacteria drug resistance) with no clear evidence that they were effective in reducing postoperative infection.”

“I think a study looking at the incidence of complications from antibiotic administration (allergic reaction, c. difficile, administration error) would be interesting. Also, perhaps looking at additional patient risk factors to see if there is a particular population that might benefit from preoperative antibiotics.”

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