{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:02:01Z","timestamp":1767772921815,"version":"3.37.3"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including \u201con-time\u201d dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's t-test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with \u201con time\u201d vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, p\u2009&lt;\u20090.01). \u201cOn Time\u201d vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI\u2009&lt;\u200945\u2009kg\/m2 (0.5 vs. 2.6%, p\u2009&lt;\u20090.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9\u2009kg\/m2 (p\u2009&lt;\u20090.01). No difference was noted for patients with a BMI\u2009\u2265\u200945\u2009kg\/m2 (3.3 vs. 2.6%, p\u2009=\u20090.71). There were no infections in 150 TKA patients with a normal BMI (18\u201325\u2009kg\/m2) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18\u201325\u2009kg\/m2) or for higher risk patients with a BMI\u2009&gt;\u200945\u2009kg\/m2.<\/jats:p>","DOI":"10.1055\/s-0040-1722350","type":"journal-article","created":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T00:27:27Z","timestamp":1611361647000},"page":"1209-1213","source":"Crossref","is-referenced-by-count":2,"title":["Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty\u2014No Benefit for Extremely Obese Patients"],"prefix":"10.1055","volume":"35","author":[{"given":"Mark K.","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4009-6193","authenticated-orcid":false,"given":"James A.","family":"Keeney","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, 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Do surgical care improvement project guidelines need to be updated?","volume":"96","author":"B Ponce","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"e1002340","DOI":"10.1371\/journal.pmed.1002340","article-title":"Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: a national propensity-score-adjusted retrospective cohort study","volume":"14","author":"W Branch-Elliman","year":"2017","journal-title":"PLoS Med"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11999-014-4062-3","article-title":"Addition of vancomycin to cefazolin prophylaxis is associated with acute kidney injury after primary total joint arthroplasty","volume":"473","author":"P M Courtney","year":"2015","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1055\/s-0035-1544974","article-title":"Modified protocol decreases surgical site infections after total knee arthroplasty","volume":"28","author":"J D Lamplot","year":"2015","journal-title":"J Knee Surg"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"2702","DOI":"10.1007\/s11999-012-2255-1","article-title":"Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty?","volume":"470","author":"A Sewick","year":"2012","journal-title":"Clin Orthop Relat Res"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1016\/j.arth.2018.03.009","article-title":"Dual-agent antibiotic prophylaxis using a single preoperative vancomycin dose effectively reduces prosthetic joint infection rates with minimal renal toxicity risk","volume":"33","author":"J R Burger","year":"2018","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.arth.2017.09.038","article-title":"Association between body mass index and thirty-day complications after total knee arthroplasty","volume":"33","author":"J George","year":"2018","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref20","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.arth.2016.05.071","article-title":"Elevated body mass index is associated with early total knee revision for infection","volume":"32","author":"A J Electricwala","year":"2017","journal-title":"J Arthroplasty"},{"issue":"24","key":"ref21","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.2106\/JBJS.17.01485","article-title":"Extended oral antibiotic prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate","volume":"100","author":"A Inabathula","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"ref22","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"J Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1722350.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T23:40:12Z","timestamp":1662421212000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1722350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":22,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,9,5]]},"published-print":{"date-parts":[[2022,9]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1722350","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"type":"print","value":"1538-8506"},{"type":"electronic","value":"1938-2480"}],"subject":[],"published":{"date-parts":[[2021,1,22]]}}}