Objective  To investigate the influencing factors of the course of perioperative prophylactic antibiotics in patients undergoing total hip arthroplasty, and explore management strategies for enhancing perioperative prophylactic medication administration.

Methods  The clinical data for patients undergoing total hip arthroplasty at Affiliated Hospital of Chengdu University from January, 2020 to September, 2024 were retrospectively collected. Patients were divided into a 24 h group and a 48-72 h group based on the duration of prophylactic antibacterial therapy. The general characteristics, surgical-related indicators, preoperative and postoperative laboratory test results, and surgical outcome measures between the two groups of patients were compared. Multivariate Logistic regression analysis was performed to identify influencing factors associated with prolonged duration of prophylactic antibacterial therapy.

Results  A total of 126 patients who underwent total hip arthroplasty were enrolled, including 74 cases in the 24 h group and 52 cases in the 48-72 h group. Univariate analysis results showed that there were statistically significant differences in the following indicators between the two groups: surgical cause, surgical duration, intraoperative blood loss, drainage duration of plasma drainage tubes, preoperative white blood cell count, and preoperative neutrophil count (P<0.05). The results of multivariate Logistic regression analysis showed that the reason for surgery and the duration of plasma drain tube drainage were the influencing factors of antimicrobial treatment course for total hip arthroplasty (P<0.05). The results of receiver operating characteristic curve analysis showed that the prediction model (constructed based on the drainage time of plasma drainage tube) for prophylactic antimicrobial treatment course to 48-72 h was 0.721. When the drainage time of plasma drainage tubes was ≥40.56  h, the risk of requiring prophylactic antimicrobial therapy for an extended course of 48-72 h increased significantly.

Conclusion  The patient's surgical reason and the duration of plasma drain drainage may be related to the prophylactic antimicrobial course of more than 24 hours. Clinical pharmacists may utilize this parameter as a patient-specific characteristic, with the support of information systems, the hierarchical patient management can be implemented, thereby enhancing the effectiveness of medication surveillance and progressively elevating the 24 h discontinuation rate of perioperative prophylactic antibiotics.

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