Wu Cheng-Ta, Chen I-Ling, Wang Jun-Wen, Ko Jih-Yang, Wang Ching-Jen, Lee Chen-Hsiang
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Infection Control, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
J Arthroplasty. 2016 Jul;31(7):1568-73. doi: 10.1016/j.arth.2016.01.017. Epub 2016 Jan 21.
Surgical site infection (SSI) after total knee arthroplasty (TKA) is a catastrophic complication. Administration of prophylactic antibiotics within 60 minutes before surgery is a well-established strategy to prevent SSI. The study is aimed to identify the risk factors for SSI regarding primary TKA in patients with timely administration of systemic prophylactic antibiotics.
A retrospective review of patients with primary TKA between 2009 and 2013 was conducted. Patients who had prophylactic antibiotics administered after skin incision or >60 minutes before skin incision were excluded.
Of the 3152 patients enrolled, the incidence of SSI and deep-implant SSI was 1.52% and 0.79%, respectively. Charlson Comorbidity Index ≥3 was an independent risk factor for both SSI (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.24-4.44, P = .01) and deep-implant SSI (OR, 3.46; 95% CI, 1.52-7.91, P < .01). Optimal dose of systemic antibiotics adjusted by patients' body weight for prophylaxis (OR, 0.29; 95% CI, 0.17-0.62, P < .01) and using antibiotic-laden bone cement (OR, 0.33; 95% CI, 0.17-0.64, P < .01) were significant protective factors for SSI. Meanwhile, using antibiotic-laden bone cement (OR, 0.31; 95% CI, 0.13-0.76, P = .01) also significantly decreased the risk of deep-implant SSI.
Our findings highlight the importance of appropriate dosage of prophylactic antibiotics and use of antibiotic-laden cement in preventing SSI after primary TKA. For prevention of deep-implant SSI, using antibiotic-laden bone cement seems to be an advisable strategy.
全膝关节置换术（TKA）后手术部位感染（SSI）是一种灾难性并发症。术前60分钟内使用预防性抗生素是预防SSI的既定策略。本研究旨在确定在及时给予全身预防性抗生素的患者中，初次TKA术后发生SSI的危险因素。
对2009年至2013年间初次行TKA的患者进行回顾性研究。排除在皮肤切开后或皮肤切开前>60分钟给予预防性抗生素的患者。
在纳入的3152例患者中，SSI和深部植入物SSI的发生率分别为1.52%和0.79%。Charlson合并症指数≥3是SSI（比值比[OR]，2.34；95%置信区间[CI]，1.24 - 4.44，P = 0.01）和深部植入物SSI（OR，3.46；95%CI，1.52 - 7.91，P < 0.01）的独立危险因素。根据患者体重调整的全身抗生素最佳预防剂量（OR, 0.29；95%CI，0.17 - 0.62，P < 0.01）和使用含抗生素骨水泥（OR，0.33；95%CI，0.17 - 0.6,4，P < 0.01）是SSI的显著保护因素。同时，使用含抗生素骨水泥（OR，0.31；95%CI，0.13 - 0.76，P = 0.01）也显著降低了深部植入物SSI的风险。
我们的研究结果强调了预防性抗生素的适当剂量和使用含抗生素骨水泥在预防初次TKA术后SSI中的重要性。对于预防深部植入物SSI，使用含抗生素骨水泥似乎是一种可取的策略。
