Wyatt Ronald W B, Maletis Gregory B, Lyon Liisa L, Schwalbe Joan, Avins Andrew L
Department of Orthopedic Surgery, Kaiser-Permanente Walnut Creek, Walnut Creek, California, U.S.A..
Department of Orthopedic Surgery, Kaiser-Permanente Baldwin Park, Baldwin Park, California, U.S.A.
Arthroscopy. 2017 Jan;33(1):157-162. doi: 10.1016/j.arthro.2016.05.020. Epub 2016 Jun 30.
To determine the association between the use of preoperative antibiotics and the risk of postoperative infection after simple knee arthroscopy.
The electronic medical records of a large integrated health care organization were used to identify patients who underwent simple knee arthroscopy between 2007 and 2012. Patient demographics, potential infection risk factors, and antibiotic administration data were extracted. Simple knee arthroscopy included debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release. Complex knee arthroscopy, septic knees, and cases involving fractures were excluded. Deep infection was defined as a positive synovial fluid culture or signs and symptoms of infection and gross pus in the knee. Superficial infection was defined as clinical signs of infection localized to a portal site and treatment with an antibiotic.
Of 40,810 simple knee arthroscopies, 32,836 (80.5%) received preoperative antibiotics and 7,974 (19.5%) did not. There were 25 deep infections in the antibiotic group (0.08%) and 11 in the no-antibiotics group (0.14%) (risk ratio = 0.55, 95% confidence interval: 0.27 to 1.12, P = .10). There were 134 superficial infections in the antibiotic group (0.41%) and 32 in the no-antibiotics group (0.40%) (risk ratio = 1.01, 95% confidence interval: 0.29 to 1.49, P = .93).
In our large sample of patients who underwent simple knee arthroscopy, there was no association between preoperative antibiotic use and postoperative deep or superficial infection rates at the 95% confidence level (P = .05). There was an association between preoperative antibiotic use and a decreased deep infection rate at the P = .10 level.
Level IV, case series.
确定单纯膝关节镜检查术前使用抗生素与术后感染风险之间的关联。
利用一家大型综合医疗保健机构的电子病历，识别2007年至2012年间接受单纯膝关节镜检查的患者。提取患者人口统计学资料、潜在感染风险因素和抗生素使用数据。单纯膝关节镜检查包括清创术、半月板切除术、半月板修复术、滑膜切除术、微骨折术和外侧松解术。复杂膝关节镜检查、感染性膝关节以及涉及骨折的病例被排除。深部感染定义为滑膜液培养阳性或有感染的体征和症状且膝关节有明显脓液。浅表感染定义为局限于切口部位的感染临床体征并使用抗生素治疗。
在40810例单纯膝关节镜检查中，32836例（80.5%）接受了术前抗生素治疗，7974例（19.5%）未接受。抗生素组有25例深部感染（0.08%），未使用抗生素组有11例（0.14%）（风险比=0.55，95%置信区间：0.27至1.12，P=0.10）。抗生素组有134例浅表感染（0.41%），未使用抗生素组有32例（0.40%）（风险比=1.01，95%置信区间：0.29至1.49，P=0.93）。
在我们对接受单纯膝关节镜检查的大量患者样本中，在95%置信水平下，术前使用抗生素与术后深部或浅表感染率之间无关联（P=0.05）。在P=0.10水平下，术前使用抗生素与深部感染率降低之间存在关联。
四级，病例系列研究。
