Lindeque Bennie, Hartman Zach, Noshchenko Andriy, Cruse Margaret
Orthopedics. 2014 Apr;37(4):257-65. doi: 10.3928/01477447-20140401-08.
The number of primary total hip arthroplasties (THAs) performed in the United States each year continues to climb, as does the incidence of infectious complications. The changing profile of antibiotic-resistant bacteria has made preventing and treating primary THA infections increasingly complex. The goal of this review was to summarize (1) the published data concerning the risk of surgical site infection (SSI) after primary THA by type of bacteria and (2) the effect of potentially modifying factors. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, EMBASE, Web of Science, and PubMed were searched. Studies dated between 2001 and 2011 examining primary THA in adults were included. Meta-analysis of the collected data was performed. The pooled SSI rate was 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883). The pooled deep prosthetic joint infection (PJI) rate was 0.9% (95% Cl, 0.4%-2.2%; P<.001; n=28,883). The pooled rate of methicillin-resistant Staphylococcus aureus SSI was 0.5% (95% Cl, 0.2%-1.5%; P<.001; n=26,703). This is approximately 20% of all SSI cases. The pooled rate of intraoperative bacterial wound contamination was 16.9% (95% Cl, 6.6%-36.8%; P=.003; n=2180). All these results had significant heterogeneity. The postoperative risk of SSI was significantly associated with intraoperative bacterial surgical wound contamination (pooled rate ratio, 2.5; 95% Cl, 1.4%-4.6%; P=.001; n=19,049).
美国每年进行的初次全髋关节置换术（THA）数量持续攀升，感染并发症的发生率亦是如此。耐抗生素细菌情况的变化使得预防和治疗初次THA感染变得日益复杂。本综述的目的是总结：（1）已发表的关于初次THA术后手术部位感染（SSI）按细菌类型划分的风险数据，以及（2）潜在影响因素的作用。检索了Cochrane对照试验中央注册库、Cochrane系统评价数据库、疗效评价文摘数据库、EMBASE、科学网和PubMed。纳入了2001年至2011年间研究成人初次THA的研究。对收集的数据进行了荟萃分析。汇总的SSI发生率为2.5%（95%置信区间[Cl]，1.4%-4.4%；P<0.001；n=28,883）。汇总的深部假体关节感染（PJI）发生率为0.9%（95%Cl，0.4%-2.2%；P<0.001；n=28,883）。耐甲氧西林金黄色葡萄球菌SSI的汇总发生率为0.5%（95%Cl，0.2%-1.5%；P<0.001；n=26,703）。这约占所有SSI病例的20%。术中细菌伤口污染的汇总发生率为16.9%（95%Cl，6.6%-36.8%；P=0.003；n=2180）。所有这些结果均存在显著异质性。SSI的术后风险与术中细菌手术伤口污染显著相关（汇总率比，2.5；95%Cl，1.4%-4.6%；P=0.001；n=19,049）。
