Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA.
Acta Orthop. 2013 Feb;84(1):82-6. doi: 10.3109/17453674.2013.769079. Epub 2013 Jan 25.
There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty.
We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission.
339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10).
EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.
目前尚无前瞻性数据表明常规胃肠内镜检查后发生人工关节感染的风险。我们旨在确定人工髋关节或膝关节置换术后患者行胃肠内镜检查后发生人工髋关节或膝关节感染的风险。
我们在一家单中心三级转诊中心进行了一项前瞻性、单病例对照研究。病例定义为 2001 年 12 月 1 日至 2006 年 5 月 31 日期间因髋关节或膝关节人工关节感染住院的成年患者。对照组为同期在同一家骨科医院住院且无关节感染诊断的髋关节或膝关节置换术患者。主要观察指标为入院前 2 年内行胃肠内镜检查后发生人工关节感染的比值比（OR）。
共纳入 339 例病例和 339 例对照。其中 70 例（21%）病例和 82 例（24%）对照在入院前 2 年内接受了胃肠内镜检查。在评估的胃肠内镜检查中，有创性食管胃十二指肠镜检查（EGD）加活检与人工关节感染风险增加相关（OR=3，95%CI：1.1-7）。在调整性别、年龄、关节年龄、免疫抑制、BMI、伤口引流、既往关节置换术、恶性肿瘤、ASA 评分和凝血酶原时间后，EGD 加活检后感染的 OR 为 4（95%CI：1.5-10）。
EGD 加活检与髋关节或膝关节置换术后人工关节感染风险增加相关。在向这些患者推荐预防性使用抗生素之前，需要在其他流行病学研究和适当的大型前瞻性临床试验中进一步证实这种关联。
