In Reply We appreciate the insights from Lipof et al about prosthetic joint infection prevention. The authors express concern that our findings may not extrapolate well to general orthopedic patients undergoing total joint replacement (TJR). Fortunately, many previous studies, including randomized clinical trials, similarly found that extended prophylaxis regimens do not reduce surgical site infections (SSI).¹ The TJRs were covered by the Surgical Care Improvement Project, which included early discontinuation of antimicrobials as a core measure; high rates of compliance with Surgical Care Improvement Project infection metrics are associated with SSI reductions, providing additional support to the notion that longer durations of prophylaxis do not improve infectious outcomes.² In our TJR cohort (n = 38 675), risk of SSI was increased in patients who received extended regimens, rising from 1.3% after less than 24 hours to 2.7% after 48 to 72 hours.³ Because of the direction of this trend, it is highly unlikely that these findings would reverse if more or lower-risk patients were included.

在答复中，我们感谢Lipof等人对预防关节假体感染的见解。作者表示担心，我们的发现可能无法很好地推广到接受全关节置换（TJR）的普通骨科患者。幸运的是，许多先前的研究，包括随机临床试验，同样发现延长的预防方案不能减少手术部位感染（SSI）。¹外科护理改善项目涵盖了TJR，其中包括尽早停用抗菌药物是一项核心措施；外科护理改善项目的高合规率与SSI的降低有关，这为以下观点提供了额外的支持：较长的预防时间不能改善感染效果。^2个在我们的TJR队列（n = 38675）中，接受延长方案的患者的SSI风险增加，从少于24小时后的1.3％增加到48至72小时后的2.7％。³由于这一趋势的方向，如果包括更多或较低风险的患者，这些发现不太可能会逆转。