Alijanipour Pouya, Heller Snir, Parvizi Javad
Department of Orthopaedics, Rothman Institute, Philadelphia, Pennsylvania.
J Knee Surg. 2014 Aug;27(4):251-8. doi: 10.1055/s-0034-1376332. Epub 2014 May 3.
Periprosthetic joint infection (PJI) following total knee arthroplasty is a major burden for patients and health systems. Prevention of this challenging complication through implementation of effective strategies should be a priority. These strategies should encompass various levels of patient care. Multiple modifiable risk factors such as uncontrolled hyperglycemia, obesity, smoking, substance abuse, and nasal colonization with Staphylococcus aureus have been described for PJI. Preoperative recognition and mitigation of these risk factors along with optimization of nonmodifiable risk factors such as kidney, liver, or immune system insufficiency can considerably decrease the risk of PJI. A comprehensive perioperative protocol should involve optimization of the operative environment to reduce the number of bacteria and particulates in the air. Several surgical and nonsurgical details of intraoperative care such as maintenance of normothermia, skin preparation, surgical field irrigation, wound closure, and duration of surgical and anesthetic procedure can influence the occurrence of PJI. Prophylactic perioperative antibiotic administration is probably one of the most important strategies in preventing PJI. Implementation of surgical safety checklist can diminish the risk of perioperative complications, particularly surgical site infection. Controversy regarding efficacy, efficiency, and optimization of some preventive measures continues to exist due to inconsistency or inadequacy of available evidence. Novel research has focused on designing PJI-resistant implants and developing vaccines that target molecule components with major role in the process of bacterial adhesion to the implant or periprosthetic tissues.
全膝关节置换术后的人工关节周围感染（PJI）对患者和卫生系统来说是一个重大负担。通过实施有效策略来预防这种具有挑战性的并发症应成为首要任务。这些策略应涵盖患者护理的各个层面。已描述了多种可改变的风险因素，如血糖控制不佳、肥胖、吸烟、药物滥用以及金黄色葡萄球菌鼻腔定植等与人工关节周围感染有关。术前识别并减轻这些风险因素，同时优化诸如肾脏、肝脏或免疫系统功能不全等不可改变的风险因素，可显著降低人工关节周围感染的风险。全面的围手术期方案应包括优化手术环境以减少空气中的细菌和微粒数量。术中护理的一些手术和非手术细节，如维持正常体温、皮肤准备、手术野冲洗、伤口闭合以及手术和麻醉过程的持续时间等，都会影响人工关节周围感染的发生。围手术期预防性使用抗生素可能是预防人工关节周围感染最重要的策略之一。实施手术安全检查表可降低围手术期并发症的风险，尤其是手术部位感染。由于现有证据的不一致或不足，关于某些预防措施的有效性、效率和优化方面的争议仍然存在。新的研究集中在设计抗人工关节周围感染的植入物以及开发针对在细菌粘附于植入物或假体周围组织过程中起主要作用的分子成分的疫苗。
