Table 2.

Evidence for antimicrobial therapy in shoulder PJI.

Evidence for antimicrobial therapy in shoulder PJI
Preoperative	Topical antibiotics e.g., Mupirocin, clindamycin.9,41
	Skin decolonisation e.g., Benzyl peroxide or chlorhexidine gluconate.12,41
	Prepare intra-operative antibiotic plan with MDT.35
Intraoperative	Intra-operative antibiotics – broad spectrum or targeted if known organism, given only after tissue and fluid sampling completed.6,35,38
	Up to 2 antibiotics to be mixed into bone cement spacer (ALBC) (if two-stage).12,35,42,43
	Consider defensive antimicrobial coating (DAC) to reduce chance of implant colonisation.44 ±
	Local antibiotics e.g., local eluting beads (e.g., Stimulan) or vancomycin powder prior to closure of wound.12 ±
Postoperative	Tissue and fluid cultured for a minimum of 14 days post-operatively.9,12,14,45
	2 weeks of intravenous therapy with switch to oral antibiotic therapy if sensitivities permit.46
	Re-discussion in MDT prior to second stage, if planned, to decide intra-operative and bone cement antibiotics.35

+-No strong evidence to support these practices in shoulder PJI.