Current reported practices in surgical antibiotic prophylaxis and infection prevention in primary arthroplasty: an open web-based survey among orthopedic specialists in Türkiye.

PURPOSE: Periprosthetic joint infection (PJI) remains a major complication after primary arthroplasty. We descriptively assessed current perioperative prophylaxis and infection-prevention practices in Türkiye by benchmarking reported practices against guideline recommendations and describing areas of variability that may warrant further evaluation.

METHOD: In this anonymous, open web-based descriptive cross-sectional survey distributed through professional networks in Türkiye (December 2025-January 2026), orthopedic and traumatology specialists reported their professional profile, systemic prophylaxis practices, and preoperative/perioperative preventive measures. Analyses were descriptive (counts, percentages).

RESULTS

A total of 278 specialists participated. Cefazolin was the first-choice prophylactic agent (100%); in β-lactam allergy, clindamycin was most preferred (73.4%). For MRSA (methicillin-resistant Staphylococcus aureus) colonization, 50.4% reported adding a glycopeptide. Initial cefazolin dosing was mostly within 60 min before incision (98.2%). Nevertheless, 53.6% extended prophylaxis beyond 24 h, 57.2% continued antibiotics until drain removal, and 62.2% prescribed oral antibiotics at discharge. Only 46.0% reported a written institutional prophylaxis protocol. Routine MRSA and MSSA (methicillin-susceptible Staphylococcus aureus) screening rates were low (19.4% and 15.1%), while asymptomatic bacteriuria screening remained high (50.0%). Preoperative bathing was recommended by 70.9%; hair removal was mainly performed with electric clippers (92.8%), usually immediately preoperatively (72.3%). Antibacterial suture use was low (9.0%), whereas antibiotic-loaded bone cement use was common (64.7%).

CONCLUSION

Reported practice appeared to align with guideline recommendations for agent selection and first-dose timing, but variability was observed in prophylaxis duration, drain/discharge-related decisions, screening-decolonization workflows, and local preventive strategies. Given the voluntary open web-based sampling strategy, unknown denominator and response rate, descriptive design, and absence of outcome correlation, these findings should be interpreted only as self-reported practices among respondents, not as representative estimates of national practice or evidence supporting practice change. Further studies with defined sampling frames, audit-based practice verification, and joint-specific outcomes are needed to evaluate how these reported variations relate to actual practice and clinical outcomes.