Chapter 19 : Antimicrobial Prophylaxis of Infections Associated with Foreign Bodies

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Antimicrobial Prophylaxis of Infections Associated with Foreign Bodies, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555818067/9781555811778_Chap19-1.gif /docserver/preview/fulltext/10.1128/9781555818067/9781555811778_Chap19-2.gif


The administration of antimicrobial agents prophylactically during the perioperative period has become standard practice for surgical procedures involving the implantation of prosthetic material, and most authorities in the field of surgical wound prophylaxis have endorsed this practice. A recent meta-analysis of nine randomized, controlled studies involving 1,045 patients undergoing placement of ventricular shunts suggested that antimicrobial prophylaxis reduced infection risk twofold, but was of apparent benefit only if infection rates in the control group were greater than 5%. While clinical studies verifying that perioperative antibiotics significantly reduce implant infection rates are not available for the majority of such procedures, significant benefits frequently have been demonstrated when infections within any part of the surgical incision, not just the prosthetic device, are included in the evaluation. Although these differences did not achieve statistical significance because of the paucity of infections observed in either group, the authors advocated the three-dose regimen pending more definitive data. In prophylaxis of prosthetic valve endocarditis, however, anecdotal associations between episodes of transient bacteremia and endocarditis have led to an almost universal recommendation for aggressive antimicrobial prophylaxis for patients with prosthetic valves who undergo dental procedures and surgery. The choice of an antimicrobial regimen and the duration of use remain matters of great confusion. When recurrent pathogens are encountered, a systematic evaluation of new prophylactic regimens, possibly in the form of ongoing randomized trials, may provide a database for a rational approach to infection prevention in implantation surgery.

Citation: Haas D, Kaiser A. 2000. Antimicrobial Prophylaxis of Infections Associated with Foreign Bodies, p 395-406. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch19

Key Concept Ranking

Infectious Diseases
Antimicrobial Prophylaxis
Staphylococcus aureus
Antibiotic Prophylaxis
Acute Infection
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1.American Society of Colon unci Rectal Surgeons. 1992. Practice parameters for antibiotic prophylaxis to prevent infective endocarditis or infected prosthesis during colon and rectal endoscopy. Dis. Colon Rectum 35:277.
2.American Society of Gastrointestinal Endoscopy. 1995. Antibiotic prophylaxis for gastrointestinal endoscopy. Gastrointest. Endoscop. 42:630635.
3. Austin, T. W.,, J. C. Coles,, R. Burnett, and VI. Goldbach. 1980. Aorlocoronary bypass procedures and sternotomy infections: a study of antistaphylococcal prophylaxis. Can. J. Surg. 23:483485.
4. Bannister, G. C.,, J. M. Auchincloss,, D. P. Johnson,, and J. H. Newman. 1988. The timing of tourniquet application in relation to prophylactic antibiotic administration. J. Bone Jr. Surg. 70-B:322324.
5. Beam, T. R., Jr. 1985. Perioperative prevention of infection in cardiac surgery. Antibiol. Chemother. 33: 114139.
6. Bennion, R. S.,, J. R. Hiatt,, R. A. Williams,, and S. E. Wilson. 1985. A randomized, prospective study of perioperative antimicrobial prophylaxis for vascular access surgery. J. Cardiovasc. Surg. 26:270274.
7. Blomstedt, G. C. 1985. Results of trimethoprim-sulfamethoxazole prophylaxis in ventriulostomy and shunting procedures: a double-blind randomized trial. J. Neurosurg. 62:694697.
8. Boyd, R. J.,, J. F. Burke,, and T. Colton. 1973. A double-blind clinical trial of prophylactic antibiotics in hip fractures. J. Bone Jt. Surg. 55-A:12511258.
9. Bryan, C. S.,, S. L. Morgan,, R. J. Caton,, and E. M. Luceford, Jr. 1988. Cefazolin versus cefamandole for prophylaxis during total joint arthroplasty. Clin. Orthop. Rel. Re.s. 228:117122.
10. Bundtzen, R. W.,, R. D. Toothaker,, 0. S. Nielson,. P. O. Madsen,. P. G. Welling,, and W. A. Craig. 1981. Pharmacokinetics of cefuroxime in normal and impaired renal function: comparison of high-pressure liquid chromatography and microbiological assays. Antimicrob. Agents Chemother. 19:443449.
11. Burnett, J. W.,, R. B. Gustilo,, D. N. Williams,, and A. C. Kind. 1980. Prophylactic antibiotics in hip fractures. J. Bone Jt. Surg. 62-A:457462.
12. Carlsson. A. S.,, L. Lidgren,, and L. Lindberg. 1977. Prophylactic antibiotics against early and late deep infections after total hip replacements. Acta Orthop. Scand. 48:405110.
13. Cioffi, G. A., , G. T. Terezhalmy,, and G. M. Taybos. 1988. Total joint replacement: a consideration for antimicrobial prophylaxis. Oral. Surg. Oral Med. Oral Pathol. 66:124129.
14. Culbertson, W. R.,, W. A. Altemeier,, L. L. Gonzales,, and E. O. Hill. 1961. Studies on the epidemiology of postoperative infection of clean operative wounds. Ann. Surg. 154:599610.
15. Dajani, A. S.,, K. A. Taubert,, W. Wilson,, A. F. Bolger,, A. Bayer,, P. Ferrieri,, M. H. Gewitz,, S. T. Shulman,, S. Nouri,. J. W. Newburger,. C. Hutto,. T. J. Pallasen,, T. W. Gage,, M. E. Levison,, G. Peter,, and G. Zuccaro, Jr. 1997. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. J. Am. Dent. Assoc. 128:11421151.
16. Deacon, J. M.,, A. J. Pagliaro,. S. B. Zelicof,, and H. W. Horowitz. 1996. Prophylactic use of antibiotics for procedures after total joint replacement. J. Bone Jt. Surg. 78-A:17551771.
17. DiPiro, J. T.,, R. P. F. Cheung,, T. A. Bowden, Jr., and J. A. Mansberger. 1986. Single dose systemic-antibiotic prophylaxis of surgical wound infections. Am. J. Surg. 152:552559.
18. Doebbeling, B. N.,, M. A. Pfaller,, K. R. Kuhns,, R. M. Massanari,. D. M. Behrendt,, and R. P. Wenzel. 1990. Cardiovascular surgery prophylaxis: a randomized, controlled comparison of cefazolin and cefuroxime. J. Thorac. Cardiovasc. Surg. 99:981989.
19. Doyon, F.,, J- Evrard,, F. Mazas,, and C. Hill. 1987. Long-term results of prophylactic cefazolin versus placebo in total hip replacement. Lancet i:860.
20. Edwards, W. H., Jr.,, A. B. Kaiser,, D. S. Kernodle,, T. C. Appleby,. W. H. Edwards, Sr.,, R. S. Martin III,, J. L. Mulherin,, and C. A. Wood, Jr. 1992. Cefuroxime versus cefazolin as prophylaxis in vascular surgery. J. Vasc. Surg. 15:3542.
21. Edwards. W. H., Jr.,, A. B. Kaiser,, S. Tapper,, W. H. Edwards, Sr.,, R. S. Martin III,, J. L. Mulherin, Jr.,, J. Jenkins,, and A. Roach. 1993. Cefamandole versus cefazolin in vascular surgical wound infections prophylaxis: cost effectiveness and risk factors. J. Vasc. Dis. 18:470475.
22. Ericson, C.,, L. Lidgren,, and L. Lindberg. 1973. Cloxacillin in the prophylaxis of postoperative infections of the hip. J. Bone Jt. Surg. 55-A:808843.
23. Espehaug, B.,, L. B. Engetaeter,, S. E. Vollset,, L. I. Havelin,, and N. Langeland. 1997. Antibiotic prophylaxis in total hip arthroplasty: review of 10,905 primary cemented total hip replacements reported to the Norwegian Arthroplasty Register. 1987 to 1995. J. Bone Jt. Surg. 79-8:590595.
24. Everett, E. D.,, and J. V. Hirschmann. 1977. Transient bacteremia and endocarditis prophylaxis: a review. Medicine 56:6177.
25. Evrard, J.,, F. Doyan,, J. F. Acar,, J. C. Mazas,, and R. Flânant. 1988. Two-day cefamandone versus five-day cefazolin prophylaxis in 965 total hip replacements. Int. Orthop. 12:6973.
26. Farber, B. F.,, A. W. Karchmer,, M. J. Buckley,, and R. C. Moellering. 1983. Vancomycin prophylaxis in cardiac operations: determination of an optimal dosage regimen. J. Thorac. Cardiovasc. Surg. 85:933940.
27. Froman, G.,, L. M. Switalski,, P. Speziale,, and M. Hook. 1987. Isolation and characterization of a fibronectin receptor from Staphylococcus aureus. J. Biol. Chem. 262:65646571.
28. Gatell, J. M.,, J. Riba,, M. L. Lozano,, J. Mana,, R. Ramon,, and J. G. SanMiguel. 1984. Prophylactic cefamdole in orthopaedic surgery. J. Bone Jt. Surg. 66:12191222.
29. Goodman, J. S.,, W. Schaffner,, H. A. Collins,, E. J. Battersby,, and M. G. Koenig. 1968. Infection after cardiovascular surgery: clinical study including examination of antimicrobial prophylaxis. N. Engl. J. Med. 278:1 17123.
30. Guglielmo, B. J.,, D. C. Holm,, P. J. Koo,, T. K. Hunt,, R. L. Sweet,, and J. E. Conte, Jr. 1983. Antibiotic prophylaxis in surgical procedures: a critical review of the literature. Arch. Surg. 118:943955.
31. Haines, S. J.,, and B. C. Walters. 1994. Antibiotic prophylaxis for cerebrospinal fluid shunts: a metanalysis. Neurosurgery 34:8793.
32. Hall, J. C.,, K. J. Christiansen,, M. Goodman,, M. Lawrence-Brown,, F. J. Prendergast,, P. Rosenberg,, B. Mills,, and J. L. Hall. 1998. Duration of antimicrobial prophylaxis in vascular surgery. Am. J. Surg. 175:8790.
33. Hasselgren, P.,, L. lvarsson,, B. Risberg,, and T. Seeman. 1984. Effects of prophylactic antibiotics in vascular surgery. Ann. Surg. 200:8692.
34. Hill, C.,, R. Flamant,, F. Mazas,, and J. Evrard. 1981. Prophylactic cefazolin versus placebo in total hip replacement. Lancet i:795797.
35. Jacobson, B.,, G. Bluhm,, I. Julander,, and C. E. Nord. 1983. Coagulase-negative staphylococci and cloxa-cillin prophylaxis in pacemaker surgery. Acta Pathol. Microbiol. Immunol. Scum!. 91:9799.
36. Jacobson, P. L.,, and W. Murray. 1980. Prophylactic coverage of dental patients with artificial joints: a retrospective analysis of thirty-three infections in hip prostheses. Oral Surg. 50:130133.
37. Jensen, L. J.,, M. T. Aagaard,, and S. Schitter. 1985. Prophylactic vancomycin versus placebo in arterial prosthetic reconstructions. Thorac. Cardiovasc. Surg. 33:300303.
38. Johnson, D. P. 1987. Antibiotic prophylaxis with cefuroxime in arthroplasty of the knee. J. Bone Jt. Surg. 69-B:787789.
39. Josefsson, G.,, L. Lindberg,, and B. Wiklander. 1981. Systemic antibiotics and gentamicin-containing bone cement in the prophylaxis of postoperative infections in total hip arthroplasty. Clin. Orthop. Rel. Res. 159: 194200.
40. Kaiser, A. B.,, K. R. Clayson,, J. L. Mulhcrin, Jr.,, A. C. Roach,, T. R. Allen,, W. H. Edwards,, and W. A. Dale. 1978. Antibiotic prophylaxis in vascular surgery. Ann. Surg. 188:283289.
41. Kaiser, A. B.,, M. R. l'etracek,, J. W. Lea IV,, D. S. Kernodle,, A. C. Roach,, W. C. Alford, Jr.,, G. R. Burrus,, D. M. Glassford, Jr.,, C. S. Thomas, Jr.,, and W. S. Stoney. 1987. Efficacy of cefazolin. cefamandole. and gentamicin as prophylactic agents in cardiac surgery: results of a prospective, randomized, double-blind trial in 1030 patients. Ann. Surg. 206:791797.
42. Kaiser, A. B. 1986. Antimicrobial prophylaxis in surgery. N. Engl. J. Med. 315:11291138.
43. Kaiser, A. B. 1991. Surgical-wound infection. N. Engl. J. Med. 324:123124.
44. Kaiser, A. B.,, and D. S. Kernodle. 1992. Inappropriate dosing of cefuroxime in cardiac surgery. J. Thorac. Cardiovasc. Surg. 103:167168.
45. Kaye, D. 1986. Prophylaxis for infective endocarditis: an update. Ann. Intern. Med. 104:419423.
46. Kernodle, D. S.,, D. C. Classen,, J. P. Burke,, and A. B. Kaiser. 1990. Failure of cephalosporins to prevent Staphylococcus aureus surgical wound infections. JAMA 263:961966.
47. Krieger, J. N.,, D. L. Kaiser,, and R. P. VVenzel. 1983. Nosocomial urinary tract infections cause wound infections postoperatively in surgical patients. Surg. Gynecol. Obstet. 156:313318.
48. Lambert, M.,, A. E. MacKinnon,, and A. Vaishav. 1984. Comparison of two methods of prophylaxis against CSF shunt infection. Z. Kinderchir. 39:109110.
49. Lidwell, O. M.,, E. J. L. Lovvbury,, W. Whyte,, R. Blowers,, S. J. Stanley,, and D. Lowe. 1982. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomized study. Br. Med. J. 285:1014.
50. Lidwell, O. M.,, R. A. Elson,, E. J. L. Lowbury,, W. Whyte,, R. Blowers,, S. J. Stanley,, and D. Lowe. 1987. Ultraclean air and antibiotics for prevention of postoperative infection. Acta Orthop. Scand. 58:413.
51. Montague, D. K. 1987. Periprosthetic infections. J. Urol. 138:6869.
52. Muers, M. F.,, A. G. Arnold,, and P. Sleight. 1981. Prophylactic antibiotics for cardiac pacemaker implantation: a prospective trial. Br. Heart J. 46:539544.
53. Newton, N. L., Jr.,, and R. Jones. 1983. Prophylactic antibiotic therapy form endophthalmitis with intraocular lens implantation. Ark. Med. Soc. 80:249252.
54. Norden, C. W. 1991. Antibiotic prophylaxis in orthopedic surgery. Rev. Infect. Dis. 13:S842S846.
55. Pavel, A.,, R. L. Smith,, A. Ballard,, and I. J. Larson. 1977. Prophylactic antibiotics in elective orthopedic surgery: a prospective study of 1.591 cases. South. Med. J. 70:5055.
56. Pitt, H. A.,, R. G. Postier,, W. A. L. MacGowan,, L. W. Frank,, A. J. Surmak,, J. V. Sitzman,, and D. Bouchier-Hayes. 1980. Prophylactic antibiotics in vascular surgery. Topical, systemic, or both? Ann. Surg. 192:356364.
57. Salzmann, G. 1983. Perioperative infection prophylaxis in vascular surgery—a randomized prospective study. Thorac. Cardiovasc. Surg. 31:239242.
58. Schmidt, K.,, F. Gjerris,, O. Osgaard,, E. F. Hvidberg. J. E. Kristiansen, B. Dahlerup, and C. Kruse-Larsen. 1985. Antibiotic prophylaxis in cerebrospinal fluid shunting: a prospective randomized trial in 152 hydrocephalic patients. Neurosurgery 17:15.
59. Silver, A.,, A. Eichorn,, J. Krai,, G. Pickett,, P. Barie,. V. Pryor,, and M. B. Dearie. 1996. Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. Am. J. Surg. 171:548552.
60. Simmons, N. A.,, A. P. Ball,, R. A. Cawson,, S. J. Fykyn,, S. P. E. Hughes,, D. A. McGowan,, and D. C. Shanson. 1992. Case against antibiotic prophylaxis for dental treatment of patients with joint prostheses. Lancet 339:301.
61. Slama, T. G.,, S. J. Sklar,, J. Misinski,, and S. W. Eess. 1986. Randomized comparison of cefamandole. cefazolin. and cefuroxime prophylaxis in open-heart surgery. Antimicrob. Agents Chemother. 29:744747.
62. Strachan, C. 1982. Antibiotic prophylaxis in "clean" surgical procedures. World J. Surg. 6:273280.
63. Sullivan, P. M.,, R. C. Johnston,, and S. S. Kelley. 1990. Late infection aller total hip replacement, caused by an oral organism after dental manipulation. J. Bone Jt. Surg. 72-A:121123.
64. Tengve, B.,, and J. Kjellander. 1978. Antibiotic prophylaxis in operations on trochanteric femoral fractures. J. Bone Jt. Surg. 60-A:9799.
65. Vaudaux, P.,, G. E. Grau,, E. Huggler,, F. Schumacher-Perdreau,, F. Fiedler,, F. A. Waldvogel,, and D. P. Lew. 1992. Contribution of tumor necrosis factor to host defense against staphylococci in a guinea pig model of foreign body infections. J. Infect. Dis. 166:5864.
66. Vaudaux, P.,, D. Pittet,. A. Haeberli,, E. Huggler,. U. E. Nydegger,, D. P. Lew,, and F. A. Waldvogel. 1989. Host factors selectively increase staphylococcal adherence on inserted catheters: a role of fibronectin anti fibrinogen or fibrin. J. Infect. Dis. 160:865875.
67. Wang, E. E. L.,, C. G. Proher,, B. E. Hendrick,, H. J. Hollinan,, and R. P. Humphreys. 1984. Prophylactic sulfamethoxazole and trimethoprim in venlriculoperitoneal shunt surgery: a double-blind, randomized, placebo-controlled trial. JAMA 251:11741177.
68. Woods, G. L.,, C. C. Knapp,, and J. A. Washington II 1987. Relationship between cefamandole and cefuroxime activity against oxacillin-resistant Staphylococcus epidermidis and oxacillin resistance pheno-type. Antimicrob. Agents Chemother. 31:13321337.
69. Worning. A. M.,, N. Frimodt-Moller,, P. Ostri,, T. Nilsson,, K. Hojholdt,, and C. Frimodt-Moller. 1986. Antibiotic prophylaxis in vascular reconstructive surgery: a double-blind placebo-controlled study. J. Antimicrob. Chemother. 17:105113.
70. Wymenga, A.,, J. van Horn,, A. Theeuwes,, H. Muytjens,, and T. Slooff. 1988. Cefuroxime for prevention of postoperative coxitis. Acta Orthop. Scand. 63:1924.
71. Yogev, A. M. 1985. Cerebrospinal Huid shunt infections: a personal view. Pediatr. Infect. Dis. 4:113118.
72. Zibari, G. B.,, M. F. Gadallah,, M. Landreneau,, R. McMillan,, R. M. Bridges,, K. Costley,, J. Work,, and J. C. McDonald. 1997. Preoperative vancomycin prophylaxis decreases incidence of postoperative hemodialysis vascular access infections. Am. J. Kidney Dis. 30:343348.


Generic image for table
Table 1

Prospective placebo-controlled trials of antimicrobial prophylaxis of foreign-device infections

Citation: Haas D, Kaiser A. 2000. Antimicrobial Prophylaxis of Infections Associated with Foreign Bodies, p 395-406. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch19
Generic image for table
Table 2

Guidelines for antimicrobial prophylaxis of implant device infections

Citation: Haas D, Kaiser A. 2000. Antimicrobial Prophylaxis of Infections Associated with Foreign Bodies, p 395-406. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch19

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error