Die perioperative Antibiotikaprophylaxe – Darstellung der aktuellen Versorgungsrealität in der Endoprothetik in Deutschland und Erstellung einer Standardarbeitsanweisung für die Primär‑, Revisions- und Tumorendoprothetik

BACKGROUND: Perioperative antibiotic prophylaxis (PAP) is one of the key measures for preventing surgical site infections (SSI). In total joint replacement (TJA), infection prevention is crucial due to the risk of bacterial biofilm formation in the event of infection. OBJECTIVE: The study's goal was to analyze the current clinical practise in German tertiary TJA centers (EPZmax), assess adherence to the currently valid German AWMF-S3 guideline, and present the contemporary literature on PAP in revision and tumor TJA. MATERIALS AND METHODS: In 2023, a nationwide survey on PAP practices was conducted among 100 EPZmax institutions. In addition, a comprehensive review of the relevant literature and guidelines was performed, and an interdisciplinary institutional standard operating procedure (SOP) was developed. RESULTS: A total of 45 centers participated in the survey. First- and second-generation cephalosporins are used in 98% of primary and 95% of revision arthroplasties. In 98% of primary and 67% of revision procedures, PAP is administered as a single dose with 95% and 77% given within 30 minutes prior to incision, respectively. The evidence level for PAP was rated by the participating centers as high in primary and low to moderate in revision arthroplasty. CONCLUSION: The survey findings demonstrate guideline-conform implementation of PAP in primary TJA but reveal a heterogeneous situation in revision TJA. The interdisciplinary SOP written by the authors is based on the recommendations of the currently valid German guideline regarding the choice of antibiotic, dosing, and timing of PAP administration as well as on the differentiated approach in patients with a documented penicillin allergy. In deviation from the currently valid German guideline, and taking into account the available evidence and international expert consensus, an extended PAP for up to 24 hours is recommended for revision and tumor TJA, in order to adequately address the particular risk profile of these procedures (increased risk of infection and the potentially very severe consequences in the event of infection).