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Addition of gentamicin for antibiotic prophylaxis in hip hemiarthroplasty does not decrease the rate of surgical site infection

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

The addition of Gram-negative coverage to antibiotic prophylaxis protocols prior to elective total hip arthroplasty (THA) has been reported to reduce periprosthetic joint infection (PJI). However, it is unknown whether adding a Gram-negative-targeted antibiotic agent improves outcomes in the trauma population. This study aimed to investigate whether the addition of a single, pre-operative dose of Gentamicin is associated with lower rates of PJI in patients undergoing hemiarthroplasty (HA) as treatment for a hip fracture.

Methods

We retrospectively reviewed cases of patients who underwent HA as treatment for a hip fracture from January 2011 to January 2022, and had a minimum 1-year of follow-up. Patients were divided into two groups based on the antibiotic prophylaxis they received during surgery: cefazolin (control group) or cefazolin with addition of Gentamicin (case group). The primary outcome was the rate of surgical site infections (SSI), and secondary outcomes included rates of prosthetic joint infection (PJI) and superficial SSIs.

Results

The final study population consisted of 1521 patients. 336 patients (22.1%) were in the case group and 1185 (77.9%) patients were in the control group. Rates of SSI were comparable between the groups (3.8% for the case group vs. 2.8% in the control group, p = 0.34). This held true for both PJIs (3.5 vs. 2.5%, p = 0.3) and superficial SSIs (0.29 vs. 0.33%, p = 0.91). The distribution of the causing pathogen was similar between the groups (p = 0.84). Gentamicin susceptibility rates of the Gram-negative bacteria associated with PJI were similar between the cohorts (p = 0.51).

Conclusions

The addition of a single, pre-operative dose of Gentamicin to the antibiotic prophylaxis protocol of patients undergoing HA as treatment for a hip fracture was not associated with lower rates of SSI, PJI or superficial SSI. The findings of this study indicate that the prophylactic benefits of Gentamicin may not apply to HA as they do to THA.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Funding

No funding was received for this project. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional Ethics Committee. Informed consent was waived due to the retrospective nature of this study.

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Authors and Affiliations

  1. Division of Orthopedics, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine Tel Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel

    Nissan Amzallag, Itay Ashkenazi, Shai Factor, Mohamed Abadi, Nadav Graif, Nimrod Snir, Aviram Gold & Yaniv Warschawski

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    Samuel Morgan

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  1. Nissan Amzallag
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All the authors that have contributed to this manuscript have agreed on the final revised version of this manuscript. Data are available at reasonable request from the corresponding author.

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Correspondence to Shai Factor.

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The authors declare that they have no conflict of interest.

Ethical statement

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional Ethics Committee. Informed consent was waived due to the retrospective nature of this study.

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Amzallag, N., Ashkenazi, I., Factor, S. et al. Addition of gentamicin for antibiotic prophylaxis in hip hemiarthroplasty does not decrease the rate of surgical site infection. Eur J Trauma Emerg Surg (2023). https://doi.org/10.1007/s00068-023-02406-6

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