万古霉素的靶向使用作为围手术期预防可降低翻修 TKA 中的假体周围关节感染。
Targeted use of vancomycin as perioperative prophylaxis reduces periprosthetic joint infection in revision TKA.
机构信息
Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
出版信息
Clin Orthop Relat Res. 2014 Jan;472(1):227-31. doi: 10.1007/s11999-013-3029-0.
BACKGROUND
The role of vancomycin in surgical antimicrobial prophylaxis and high-risk patients who are most likely to benefit remains unclear.
QUESTIONS/PURPOSES: We determined the impact of targeted use of vancomycin on (1) the incidence of periprosthetic joint infection (PJI); and (2) the incidence of PJI from methicillin-resistant organisms in patients undergoing revision total knee arthroplasty (TKA) at our institution.
METHODS
In an effort to reduce PJI rates, we added vancomycin to cefazolin as surgical antimicrobial prophylaxis for patients undergoing revision TKA in October 2010. Internal data indicated a high rate of PJI in revision TKA and in particular PJI resulting from methicillin-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus epidermidis (MRSE). We retrospectively reviewed infection control surveillance data on 414 revision TKAs performed between July 2008 and June 2012 (fiscal years 2009-2012).
RESULTS
The overall rate of PJI in fiscal years 2009-2010 among 190 patients undergoing revision TKA was 7.89%. After the change in surgical antimicrobial prophylaxis, there was a significant reduction in PJI among patients undergoing revision TKA in fiscal years 2011-2012 to 3.13% (p = 0.046). In particular, we observed a reduction in PJI resulting from methicillin-resistant organisms over this same time period, from 4.21% to 0.89% (p = 0.049).
CONCLUSIONS
Targeted use of vancomycin in patients undergoing revision TKA was effective in reducing the rate of PJI and PJI resulting from methicillin-resistant organisms in an institution with a high baseline rate of PJI due to MRSA and MRSE. Identification of high-risk subgroups of patients within a surgical population can help target infection prevention strategies to those who are most likely to benefit and thus minimize potential risks (eg, selection of resistant organisms, adverse drug events) associated with broader application of such an intervention.
背景
万古霉素在外科抗菌预防和最有可能受益的高危患者中的作用仍不清楚。
问题/目的：我们确定了靶向使用万古霉素对（1）假体周围关节感染（PJI）的发生率；（2）我们机构行翻修全膝关节置换术（TKA）患者中耐甲氧西林的生物体引起的 PJI 的发生率的影响。
方法
为了降低 PJI 率，我们于 2010 年 10 月在接受翻修 TKA 的患者中，将万古霉素添加到头孢唑啉中作为外科抗菌预防。内部数据表明，翻修 TKA 的 PJI 发生率较高，特别是耐甲氧西林的生物体引起的 PJI，包括耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林表皮葡萄球菌（MRSE）。我们回顾性地审查了 2008 年 7 月至 2012 年 6 月（2009-2012 财年）期间进行的 414 例翻修 TKA 的感染控制监测数据。
结果
2009-2010 财年 190 例接受翻修 TKA 的患者中，总体 PJI 发生率为 7.89%。改变外科抗菌预防措施后，2011-2012 财年接受翻修 TKA 的患者 PJI 发生率显著降低至 3.13%（p=0.046）。特别是，在同一时期，我们观察到耐甲氧西林生物体引起的 PJI 减少，从 4.21%降至 0.89%（p=0.049）。
结论
在一个由于 MRSA 和 MRSE 而 PJI 基线率较高的机构中，在接受翻修 TKA 的患者中靶向使用万古霉素可有效降低 PJI 率和耐甲氧西林生物体引起的 PJI。在手术人群中确定高危亚组患者，可以帮助将感染预防策略针对最有可能受益的人群，从而最大限度地减少与这种干预措施广泛应用相关的潜在风险（例如，选择耐药生物体，药物不良事件）。
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