Surgical antibiotic prophylaxis for patients with a pre-existing joint prosthesis

Although surgical procedures can result in incidental bacteraemia, there is a low risk of seeding of the joint prosthesis and subsequent infection. Accumulated evidence supports the same approach to surgical antibiotic prophylaxis for patients with and without a pre-existing joint prosthesis; neither the indication for prophylaxis nor the choice of antibiotic regimen is altered by the presence of a joint prosthesis. This is true even for procedures that commonly cause bacteraemia (eg tooth extractions, periodontal procedures, cystoscopy, insertion of an indwelling urinary catheter, perforating dermatological procedures). The potential adverse effects outweigh the potential benefits of prophylaxis¹.