[Impact of preoperative therapeutic antibiotic use on pathogen detection rate in single-stage revision of chronic periprosthetic joint infection].

OBJECTIVE: To investigate the impact of intravenous administration of therapeutic antibiotics prior to skin incision on the intraoperative pathogen detection rate and clinical outcomes in single-stage revision for chronic periprosthetic joint infection (PJI).

METHODS: A retrospective analysis was conducted on the clinical data of 65 patients with chronic PJI who met the selection criteria and underwent single-stage revision between January 2020 and June 2025. Based on the timing of antibiotic administration, the patients were divided into a preoperative antibiotic group (Pre-Abx group, n=31, intravenous infusion started 60-120 minutes before skin incision) and an intraoperative antibiotic group (Intra-Abx group, n=34, administration started after the removal of the infected prosthesis and thorough debridement). Intraoperative joint fluid, periprosthetic tissue, and prosthesis sonication fluid were collected. The overall pathogen detection rate, culture-positive rates of various specimen types, and pathogen distribution were compared between the two groups. According to the Musculoskeletal Infection Society (MSIS) criteria, the proportions of patients meeting the major criteria, minor criteria, and those with culture-negative PJI were analyzed. Subgroup analyses were performed based on the antibiotic regimen (broad-spectrum or pathogen-specific antibiotics) and administration timing (Pre-Abx or Intra-Abx group) to compare the intraoperative culture-positive rates. Clinical outcomes, including infection control rate, length of hospital stay, reoperation rate, and postoperative complications, were also analyzed.

RESULTS: The overall pathogen detection rate for all patients was 81.54% (53/65). Coagulase-negative staphylococci were the most common pathogens (26.15%), followed by Staphylococcus aureus (16.92%) and methicillin-resistant Staphylococcus aureus (MRSA, 15.38%). There was no significant difference between the two groups in pathogen distribution, overall detection rate (80.65% vs. 82.06%), and culture-positive rates of various specimen types (joint fluid, periprosthetic tissue, and sonication fluid) ( P>0.05). When classified by MSIS criteria, the proportions of patients meeting the major criteria, minor criteria, and those with culture-negative PJI also showed no significant difference between the two groups ( P>0.05). Subgroup analyses revealed that regardless of whether a broad-spectrum or pathogen-specific antibiotic regimen was used, the timing of administration did not affect the pathogen detection rate ( P>0.05). Furthermore, under the same administration timing, different types of antibiotics had no significant effect on the detection rate ( P>0.05). All patients were followed up 12-45 months with a mean duration of 22.69 months. The overall infection control rate was 83.08% (54/65), with 87.10% and 79.41% in the Pre-Abx and Intra-Abx groups, respectively, showing no significant difference ( P>0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). During the follow-up period, 5 and 7 patients in the Pre-Abx group and Intra-Abx group underwent reoperation, respectively, and there was no significant difference in the reoperation rate between the two groups ( P>0.05). Regarding complications, 1 case of prosthesis dislocation and 2 cases of poor wound healing occurred in the Pre-Abx group, while 1 case of sepsis and 4 cases of poor wound healing occurred in the Intra-Abx group; the incidence rates of these complications did not differ significantly between the two groups ( P>0.05).

CONCLUSION: In single-stage revision for chronic PJI, the intravenous administration of therapeutic antibiotics prior to skin incision does not significantly reduce the intraoperative pathogen detection rate, nor does it negatively affect the infection control rate or postoperative complications. It can serve as a viable alternative strategy for perioperative antibiotic management.