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Cefuroxime Prophylaxis in Total Joint Arthroplasty: Need for Antibiotic Stewardship.

The efficacy of prophylactic antibiotics for Total Joint Arthroplasty (TJA) has been well established. Perioperative antimicrobial prophylaxis for TJA has been shown to reduce the risk of Prosthetic Joint Infection (PJI) by more than 80% [1]. The selection of prophylactic antibiotics requires an understanding of the common microorganisms causing PJIs. The most prevalent causative organisms involved in PJIs are Staphylococcus aureus and coagulase negative staphylococci [2]. Gram-negative bacilli are involved to a much lesser extent (< 10%) [2]. According to the American Academy of Orthopaedics Surgeons (AAOS, 2004) the preferred antimicrobial prophylaxis for TJA is cefazolin or cefuroxime [3]. In recent years, Methicillin resistant Staphylococcus aureus (MRSA) and Gram-negative bacilli that are resistant to antibiotics are increasingly being reported as nosocomial pathogens [4,5]. Thus, the use of antimicrobial agents effective against these microorganisms is necessary in the prophylaxis for prosthetic orthopaedic surgeries. Although antimicrobial resistance is a pertinent problem in India, there is a paucity of microbiological data from periprosthetic joint infections [6]. This prompted us to prospectively study all joint arthroplasties complicated by infections to determine the bacteria involved in these infections and their antimicrobial susceptibility profile.