The Journal of arthroplasty · 2026
The Efficacy of Cefazolin Alternatives for Periprosthetic Joint Infection Prevention After Primary Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.
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Kanumuri Sanjana D, Dasari Suhas P, Roth Owen S, Yang Jaewon, Fernando Navin, Hernandez Nicholas
Аннотация
BACKGROUND: Periprosthetic joint infection (PJI) remains a challenging complication following total joint arthroplasty (TJA). Current guidelines recommend the use of first-generation cephalosporins for prophylactic antibiotic coverage. The primary aim of this investigation was to determine if there was a difference in the incidence of postoperative PJI between TJA patients who were treated with cefazolin and noncefazolin prophylaxis. The secondary aim of this study was to evaluate differences among those treated with cefazolin prophylaxis and higher generation cephalosporins.
METHODS: Multiple databases were queried for literature comparing the clinical outcomes between patients who were treated with cefazolin prophylaxis and those treated with noncefazolin prophylaxis, including higher-generation cephalosporins. The primary outcome was PJI rates. A random effects model was used to compare the relative risk of PJI in the two pooled cohorts. There was a total of 2,303,501 patients included in this study across 18 studies.
RESULTS: Patients who were treated with cefazolin were 45% less likely to develop a PJI relative to patients who were treated with vancomycin with/without clindamycin (P = 0.004). Patients who were treated with cefazolin were 34% less likely to develop a PJI relative to patients who were treated with noncephalosporin antibiotics (P = 0.004). When comparing patients who were treated with cefazolin with those who were treated with higher-generation cephalosporins, there were no significant differences. Further studies are needed to assess variability due to heterogeneity in effect sizes across the meta-analysis (I2= 88%, Tau 0.20), likely from differences within antibiotic regimens.
CONCLUSIONS: Compared to all noncephalosporin antibiotics and specifically vancomycin with/without clindamycin, cefazolin was associated with a significantly lower rate of PJI following TJA. There were no significant differences observed when comparing cefazolin to higher generation cephalosporins. Further research is warranted to elucidate the ideal antibiotic prophylaxis for TJA, especially given differences in timing and reasons for selection of antibiotics.
METHODS: Multiple databases were queried for literature comparing the clinical outcomes between patients who were treated with cefazolin prophylaxis and those treated with noncefazolin prophylaxis, including higher-generation cephalosporins. The primary outcome was PJI rates. A random effects model was used to compare the relative risk of PJI in the two pooled cohorts. There was a total of 2,303,501 patients included in this study across 18 studies.
RESULTS: Patients who were treated with cefazolin were 45% less likely to develop a PJI relative to patients who were treated with vancomycin with/without clindamycin (P = 0.004). Patients who were treated with cefazolin were 34% less likely to develop a PJI relative to patients who were treated with noncephalosporin antibiotics (P = 0.004). When comparing patients who were treated with cefazolin with those who were treated with higher-generation cephalosporins, there were no significant differences. Further studies are needed to assess variability due to heterogeneity in effect sizes across the meta-analysis (I2= 88%, Tau 0.20), likely from differences within antibiotic regimens.
CONCLUSIONS: Compared to all noncephalosporin antibiotics and specifically vancomycin with/without clindamycin, cefazolin was associated with a significantly lower rate of PJI following TJA. There were no significant differences observed when comparing cefazolin to higher generation cephalosporins. Further research is warranted to elucidate the ideal antibiotic prophylaxis for TJA, especially given differences in timing and reasons for selection of antibiotics.