Department of Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
Int J Infect Dis. 2011 Dec;15(12):e867-70. doi: 10.1016/j.ijid.2011.09.009. Epub 2011 Oct 20.
The aim of this study was to evaluate the outcome of cefazolin prophylaxis for total knee arthroplasty (TKA) in a hospital with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection.
Since July 1, 2006, we have applied a 'care bundle' to TKA to prevent surgical site infection (SSI) without using vancomycin as antimicrobial prophylaxis, in accordance with the 1999 Hospital Infection Control Practices Advisory Committee guidelines. All patients undergoing TKA from July 1, 2006 to September 30, 2009 were enrolled. We reviewed data on SSI collected prospectively as part of routine infection control surveillance.
Of 1323 TKAs, an SSI developed in 14 (1.06%) cases, which is comparable to the percentage obtained in other previous reports. When stratified by the National Nosocomial Infection Surveillance risk index, SSI rates were 0.86% (8/926), 1.30% (5/384), and 7.69% (1/13) in risk categories 0, 1, and 2, respectively. Of 14 SSIs, four (29%) were classified as superficial incisional, two (14%) as deep incisional, and eight (57%) as organ-space SSI.
Our data suggest that antimicrobial prophylaxis using only cefazolin can maintain low SSI rates if other important infection management measures are employed, even where there is a high prevalence of MRSA infection.
本研究旨在评估高耐甲氧西林金黄色葡萄球菌（MRSA）感染医院中头孢唑林预防全膝关节置换术（TKA）的效果。
自 2006 年 7 月 1 日起，我们根据 1999 年医院感染控制实践咨询委员会指南，应用“护理捆绑包”来预防手术部位感染（SSI），而不使用万古霉素作为抗菌预防药物。所有 2006 年 7 月 1 日至 2009 年 9 月 30 日期间接受 TKA 的患者均被纳入研究。我们回顾了作为常规感染控制监测的一部分前瞻性收集的 SSI 数据。
在 1323 例 TKA 中，14 例（1.06%）发生 SSI，与其他先前报告的百分比相当。按照国家医院感染监测风险指数分层，风险类别为 0、1 和 2 的 SSI 发生率分别为 0.86%（8/926）、1.30%（5/384）和 7.69%（1/13）。在 14 例 SSI 中，4 例（29%）为浅表切口感染，2 例（14%）为深部切口感染，8 例（57%）为器官间隙感染。
我们的数据表明，如果采用其他重要的感染管理措施，仅使用头孢唑林进行抗菌预防可以维持较低的 SSI 发生率，即使存在高 MRSA 感染率的情况下也是如此。
