{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:17:45Z","timestamp":1787753865713,"version":"build-2784847793"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Periprosthetic joint infections (PJI) caused by\n                      <jats:italic toggle=\"yes\">Cutibacterium<\/jats:italic>\n                      spp. are frequently observed in total hip arthroplasty (THA) using the direct anterior approach (DAA). The microbiological spectrum of PJI after DAA differs from that of a lateral based approach. The aim of this study was to compare a dual-antibiotic (AB)-prophylaxis with cefuroxime (CEF) and doxycycline (DOX) to mono-AB-prophylaxis with CEF alone in DAA THA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 4,430 primary THAs receiving CEF prophylaxis were compared with 3,487 THAs receiving CEF+DOX prophylaxis. The institutional AB-prophylaxis was changed from cefuroxime 1.5-3 g (CEF group) alone to cefuroxime 1.5-3 doxycycline 300 mg (CEF+DOX group). A multivariable binary logistic regression analysis to evaluate the association between CEF vs. CEF+DOX and the occurrence of PJI (according to the International Consensus Meeting 2018) was performed with dropping 3 months before and after the change (covariates: American Society of Anesthesiologists, Charlson Comorbidity -Index, age, body mass index [BMI], smoking status, and diabetes mellitus [DM]). The primary outcome was the incidence of PJI following THA after a minimum follow-up of 1 year, with an accompanying analysis of the microbiological spectrum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 7,917 (age: 65.8 (65.5; 66.0) years; female: 61.2%; male: 38.8%) THA were analyzed for this study. After a median follow-up of 4.3 years (interquartile-range: 2.0-6.2), no significant difference in the incidence of septic revision was observed between the CEF and CEF+DOX therapy with an infection rate of 1.3% and 1.0%, respectively (p = 0.172). The septic-free revision rate at 1 year was 99.0% in the CEF group and 99.1% in the CEF+DOX group (p = 0.541). Due to the longer follow-up, the CEF group experienced more THA with aseptic loosening compared to the CEF+DOX group. The type of AB prophylaxis was not associated with a clinically relevant higher risk of PJI (odds ratio [OR] = 1.03; 95% CI: 0.99-1.07; p = 0.052). Only BMI demonstrated a significant association with PJI (OR = 1.12; 95% CI: 1.09-1.16; p &lt; 0.001). In the CEF+DOX group,\n                      <jats:italic toggle=\"yes\">Cutibacterium avidum<\/jats:italic>\n                      was more frequent (15.7% vs. 8.1%) and\n                      <jats:italic toggle=\"yes\">Cutibacterium Acnes<\/jats:italic>\n                      was less frequent (9.8% vs. 12.3%) compared with the CEF group (p = 0.143 and p = 0.809, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      This study showed no superiority in the rate of PJI between CEF+DOX and CEF alone in DAA THA. DOX does not prevent\n                      <jats:italic toggle=\"yes\">Cutibacterium<\/jats:italic>\n                      -positive PJIs. There are factors other than AB prophylaxis that influence the risk of PJI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Diagnostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.oa.25.00259","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T19:00:55Z","timestamp":1766430055000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Dual Antibiotic Prophylaxis with Addition of Doxycycline Does Not Lower Periprosthetic Infection Rate in Primary Directed Anterior Total Hip Replacement"],"prefix":"10.2106","volume":"10","author":[{"given":"Sebastian","family":"Simon","sequence":"first","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"},{"name":"Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma","family":"Tobudic","sequence":"additional","affiliation":[{"name":"Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5465-3459","authenticated-orcid":false,"given":"Jennyfer A.","family":"Mitterer","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"},{"name":"Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria"},{"name":"AUVA Trauma Center Meidling, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-9226","authenticated-orcid":false,"given":"Stephanie","family":"Huber","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"},{"name":"Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2575-4207","authenticated-orcid":false,"given":"Sujeesh","family":"Sebastian","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4872-2997","authenticated-orcid":false,"given":"Susana","family":"Gardete-Hartmann","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6445-3280","authenticated-orcid":false,"given":"Christian","family":"Woisetschlaeger","sequence":"additional","affiliation":[{"name":"II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4653-0739","authenticated-orcid":false,"given":"Jochen G.","family":"Hofstaetter","sequence":"additional","affiliation":[{"name":"Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Austria"},{"name":"II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria"},{"name":"School of Medicine, Sigmund Freud University Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10]]},"reference":[{"issue":"8","key":"R1-20251222","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg."},{"issue":"8","key":"R2-20251222","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.arth.2022.01.019","article-title":"Preoperative prophylactic antibiotics in total hip and knee arthroplasty: what, when, and how","volume":"37","author":"Spangehl","year":"2022","journal-title":"J 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