The use of prophylactic antimicrobial agents during and after hip arthroplasty

An intravenous antibiotic, administered just before skin incision, effectiv ely reduces the prevalence of deep wound infection. The optimal antimicrobi al agent has not been determined definitively; however, a short duration of prophylaxis is recommended, Institutional compliance strategies are cost-e ffective and improve the timing of antibiotic administration. Also, publish ed antimicrobial restriction recommendations are warranted because of the c oncern of emerging antibiotic-resistant bacteria. Specifically, restriction of vancomycin in orthopaedic surgery should be targeted critically. Supple mental antibiotic administration includes additional intraoperative antibio tic dosing, use of antibiotic-irrigant solutions, and admixture of antibiot ics into acrylic bone cement or bone graft, There are no established standa rds or clinical guidelines for these supplemental antibiotic applications. Postoperatively, antimicrobial agents frequently are overused for various c linical scenarios and this pattern of antibiotic usage is potentially detri mental. A prophylaxis strategy for prevention of early and late hematogenou s infection requires consideration of host risk factors, wound environment variables, and sources of potential bacteremia. This strategy should includ e deliberation of the cost-effectiveness, efficacy, and complications assoc iated with routine use of antibiotics. Advisory statements for elective pro cedures, which potentially may cause bacteremia, are being developed and ad ditional research is required for this area of antimicrobial agent prophyla xis.