Postoperative infections following total knee replacement: An epidemiological study

From January 1991 to June 1997 217 patients undergoing monolateral or bilat eral total knee replacement (TKR) were consecutively enrolled in a prospect ive study on the incidence of postoperative infections and related risk fac tors, Regional antimicrobial prophylaxis (teicoplanin 400 mg) was used in 2 63 (95%) prostheses implanted; in the remaining 14 implants (5%) perioperat ive antibiotic prophylaxis (teicoplanin 800 mg) was administered as usual b y systemic route. None of the patients experienced local or systemic advers e effects, Over the 2-year follow-up period, 8 (2.9%) primary site infectio us complications were recorded, i.e. 4 superficial infections, which were c ured without involvement of the prostheses, and 4 deep infections, which re quired prosthesis removal. Six infections occurred in patients who had unde rgone previous surgery of the same knee joint, and 2 in patients undergoing primary TKR (p= 0.0005); diabetic patients had infections (13%) more frequ ently than non-diabetic patients (1.9%, p=0.01), Staphylococci were the lea ding organisms isolated from infections; however 3 strains of Escherichia c oli were isolated from patients who had undergone a previous prosthesis imp lantation at the same knee joint. Regional administration of teicoplanin ap pears to be a safe and valuable prophylactic technique; however, in patient s at risk of infection a prophylactic regimen which is also active against Gram-negative bacteria should probably be considered.