Shorter antimicrobial prophylaxis duration is noninferior in preventing health care-associated infections following clean orthopedic surgery, according to a study published online April 12 in JAMA Network Open.

Kosei Nagata, Ph.D., from the University of Tokyo Hospital, and colleagues examined whether a shorter antimicrobial prophylaxis duration (<24 hours after surgery) is inferior to a longer duration in preventing health care-associated infections after clean orthopedic surgery. The analysis included 1,211 participants randomly assigned to discontinuation of antimicrobial prophylaxis within 24 hours after surgery or between 24 and 48 hours after surgery.

The researchers found that health care-associated infections occurred in 4.6 percent of patients discontinued within 24 hours and in 6.6 percent of those discontinued within 48 hours. A risk difference of −1.99 percentage points (95 percent confidence interval, −5.05 to 1.06 percentage points; P < 0.001 for noninferiority) was seen between the groups, indicating noninferiority. Results were similar in adjusted intention-to-treat, per-protocol, and per-designated procedure population analyses, without a risk for antibiotic resistance and prolonged hospitalization.

“These findings lend support to the global movement against antimicrobial resistance and provide additional information on adequate antimicrobial prophylaxis for clean orthopedic surgery,” the authors write.

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