Among patients who underwent clean orthopedic procedures, antibiotic prophylaxis (ABP) discontinuation within 24 hours after wound closure was noninferior to discontinuation within 48 hours for the prevention of health care–associated infections (HAIs), according to results of a study in JAMA Network Open.

This open-label, cluster randomized trial was conducted at multiple centers in Japan between May 2018 and December 2018. Eligible patients included those who were aged 20 years and older, and clean orthopedic procedures were determined via the Centers for Disease Control and Prevention’s wound classification system. The primary outcome was the incidence of postoperative HAIs requiring antibiotic therapy within a 30-day period.

A total of 1211 patients included in the analysis, of whom 633 discontinued ABP within 24 hours (group A) and 578 discontinued ABP within 24 to 48 hours (group B). Among patients in groups A and B, the median age was 73 (IQR, 61-80) and 74 (IQR, 62-81) years, and 60.5% and 64.7% were women, respectively.


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A total of 29 (4.6%) HAIs (4.6%) occurred among patients in group B vs 38 (6.6%) among those in group B, indicating a significantly decreased risk for HAIs among those in whom ABP was discontinued within 24 hours (risk difference [RD], -1.99; 95% CI, -5.05 to 1.06; P < .001).

Similar findings were observed among the adjusted intention-to-treatment population, which excluded patients who deviated from the protocol indicated by their assigned group. Findings also were similar after the exclusion of patients who received local antibiotics and those in whom iodine-impregnated adhesive drapes and antimicrobial-coated sutures for the prevention of surgical site infections (SSIs) were not used.

The occurrence of SSIs, urinary tract infections, and respiratory tract infections was decreased among patients in Group A vs Group B (RD, -1.08; 95% CI, -2.98 to 0.83). No significant between-group differences were observed in the crude estimate of postoperative hospitalizations for HAIs within 30 days (hazard ratio [HR], 1.17; 95% CI, 0.86-1.60). Further analysis showed that the risk for antimicrobial-resistant pathogens among patients in Group A (n=2) vs Group B (n=4) who developed HAIs was not significantly different (RD, -0.38; 95% CI, -1.31 to 0.59).

Limitations included the inability to completely blind group allocations, potential selection bias, and limited generalizability due to differences in patient care between Japan and other countries.

“Our findings support the global aim against antimicrobial resistance, which may reduce the socioeconomic burden, especially in institutions where prolonged [ABP] duration is still implemented,” the researchers concluded.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Nagata K, Yamada K, Shinozaki T, et al. Effect of antimicrobial prophylaxis duration on health care–associated infections after clean orthopedic surgery: a cluster randomized trial. JAMA Netw Open. 2022;5(4):e226095. doi: 10.1001/jamanetworkopen.2022.6095