Preoperative assessment of skin colonization and antibiotic effectiveness in total knee arthroplasty.

A bacteriologic screening procedure was performed to preoperatively assess the skin flora of 152 total knee arthroplasty patients and to determine the appropriate prophylactic antibiotic and skin-cleansing technique. Staphylococcus epidermidis resistant to standard prophylactic antibiotics was present in 4.6% of patients, whereas 44% of the patients had Staphylococcus aureus, which is poorly eradicated by standard cleansing techniques. Preoperative assessment of skin colonization has demonstrated that standard preoperative antibiotics and skin-cleansing techniques will not completely eradicate all pathogenic skin bacteria in every case. Preoperative screening effectively identifies bacterial skin flora and allows for the modification of antibiotic selection and preoperative cleansing to eradicate resistant bacterial organisms and thereby decrease the risk of postoperative prosthetic infections.