INCREASED RISK OF PERIPROSTHETIC JOINT INFECTION FOLLOWING PRIMARY TOTAL KNEE ARTHROPLASTY AND TOTAL HIP ARTHROPLASTY WITH ALTERNATIVES TO CEFAZOLIN: THE VALUE OF ALLERGY TESTING FOR ANTIBIOTIC PROPHYLAXIS

Introduction First generation cephalosporins remain the gold standard perioperative antibiotic for total hip and knee arthroplasty (THA, TKA). However, some patients have documented or self-reported allergies to antibiotics, most commonly penicillin, that result in changes to perioperative antibiotic coverage. Furthermore, patients testing positive for methicillin resistant staphylococcus aureus (MRSA) represent another group where an alternative to cefazolin, typically vancomycin, is often chosen for perioperative prophylaxis. The aims of this study were to 1) characterize the antibiotic choices for perioperative prophylaxis at the time of primary TKA and THA, 2) assess the efficacy of a preoperative antibiotic allergy testing program, and 3) determine rates of periprosthetic joint infection (PJI) based on perioperative antibiotic regimen. Methods We evaluated all patients undergoing primary TKA or THA at a single academic institution from January 2004-May 2017, yielding a cohort of 29,695 patients. A se...