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Background <p>Implant-based orthopaedic procedures, such as total hip and knee arthroplasty and instrumented spinal fusion, are vulnerable to postoperative infection because implants facilitate microbial adherence and biofilm formation, and infections carry substantial morbidity, revision burden, and cost. Although major guidance emphasizes time-limited perioperative prophylaxis, some clinicians extend antibiotics after discharge, most commonly as extended oral antibiotic prophylaxis, particularly in patients perceived to be high risk.</p> Main Body <p>We performed a structured, search-informed narrative synthesis of English-language evidence published from January 2015 through January 2026 and summarized major guideline and consensus positions to characterize procedure-specific prescribing patterns, comparative outcomes, and stewardship-relevant trade-offs. In total joint arthroplasty, supportive findings largely derive from retrospective cohorts in selected high-risk populations, but definitions of high risk, antibiotic regimens, and follow-up windows vary substantially, and conflicting observational studies and matched analyses limit certainty and generalizability. In instrumented spine surgery, post-discharge prescribing variation is well documented, yet comparative evidence generally does not demonstrate a consistent reduction in surgical site infection with prolonged postoperative or post-discharge prophylaxis. Across procedures, extended antibiotic exposure plausibly increases patient-centered harms, including gastrointestinal intolerance, drug reactions, acute kidney injury, and Clostridioides difficile infection, while population-level concerns include resistance selection and inefficient resource use when baseline infection risk is low.</p> Conclusion <p>A stewardship-aligned approach should prioritize standard short-course prophylaxis for most clean elective cases and reserve post-discharge prophylaxis for narrowly defined very-high-risk subgroups within protocolized governance, explicit stop dates, early reassessment, and adverse-event monitoring. Key research priorities include standardized risk definitions, rigorous outcome adjudication, and scalable pragmatic or registry-randomized designs.</p>

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Post-Discharge Antibiotic Prophylaxis in Arthroplasty and Spine Surgery: A Narrative Review of Evidence, Harms, and a Stewardship Framework

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Saied Besharaty,
  • Shahab Sheikhalishahi,
  • Hesameddin Jafarinasab

摘要

Background

Implant-based orthopaedic procedures, such as total hip and knee arthroplasty and instrumented spinal fusion, are vulnerable to postoperative infection because implants facilitate microbial adherence and biofilm formation, and infections carry substantial morbidity, revision burden, and cost. Although major guidance emphasizes time-limited perioperative prophylaxis, some clinicians extend antibiotics after discharge, most commonly as extended oral antibiotic prophylaxis, particularly in patients perceived to be high risk.

Main Body

We performed a structured, search-informed narrative synthesis of English-language evidence published from January 2015 through January 2026 and summarized major guideline and consensus positions to characterize procedure-specific prescribing patterns, comparative outcomes, and stewardship-relevant trade-offs. In total joint arthroplasty, supportive findings largely derive from retrospective cohorts in selected high-risk populations, but definitions of high risk, antibiotic regimens, and follow-up windows vary substantially, and conflicting observational studies and matched analyses limit certainty and generalizability. In instrumented spine surgery, post-discharge prescribing variation is well documented, yet comparative evidence generally does not demonstrate a consistent reduction in surgical site infection with prolonged postoperative or post-discharge prophylaxis. Across procedures, extended antibiotic exposure plausibly increases patient-centered harms, including gastrointestinal intolerance, drug reactions, acute kidney injury, and Clostridioides difficile infection, while population-level concerns include resistance selection and inefficient resource use when baseline infection risk is low.

Conclusion

A stewardship-aligned approach should prioritize standard short-course prophylaxis for most clean elective cases and reserve post-discharge prophylaxis for narrowly defined very-high-risk subgroups within protocolized governance, explicit stop dates, early reassessment, and adverse-event monitoring. Key research priorities include standardized risk definitions, rigorous outcome adjudication, and scalable pragmatic or registry-randomized designs.