Tan Timothy L, Gomez Miguel M, Kheir Michael M, Maltenfort Mitchell G, Chen Antonia F
Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2017 Apr;32(4):1089-1094.e3. doi: 10.1016/j.arth.2016.11.021. Epub 2016 Nov 23.
Preoperative antibiotic prophylaxis remains one of the most important strategies for preventing periprosthetic joint infection (PJI). Current guidelines recommend giving universal antibiotic prophylaxis to all total joint arthroplasty patients regardless of their medical conditions or immune status; however, no studies have evaluated the individualizing of antibiotics. The aims of this study were (1) to determine if comorbidities influence the organism profile of PJIs, and (2) to investigate if the efficacy of two different perioperative antibiotics (cefazolin or vancomycin) for preventing PJI is affected by patient's comorbidities.
Using an institutional database of 1022 PJIs, the influence of different patient's comorbidities on the organism profile was evaluated. To investigate the influence of perioperative antibiotics (cefazolin or vancomycin monotherapy) on PJI rate, 8575 primary total joint arthroplasties were identified, crossmatched for PJI, and analyzed based on the comorbidities of the cohort. The PJI rate of each antibiotic within each comorbidity was compared.
Although no comorbidities were associated with an increased rate of Gram-positive infections or Gram-negative infections, metastatic disease (odds ratio [OR] 5.71, P = .018), congestive heart failure (OR 2.2, P = .010), chronic pulmonary disease (OR 1.76, P = .015), and diabetes mellitus (OR 1.66, P = .019) were associated with antibiotic resistant organisms. However, there was no difference in the PJI rate between cefazolin and vancomycin monotherapy when stratifying for diabetes mellitus, rheumatoid arthritis, liver disease, and hypothyroidism.
The results of the present study support the current recommendations of a universal antibiotic prophylaxis protocol rather than an antibiotic regimen individualized to a patient's comorbidities.
术前抗生素预防仍然是预防人工关节周围感染（PJI）最重要的策略之一。当前指南建议对所有全关节置换患者进行普遍的抗生素预防，无论其病情或免疫状态如何；然而，尚无研究评估抗生素的个体化应用。本研究的目的是：（1）确定合并症是否会影响PJI的微生物谱；（2）研究两种不同的围手术期抗生素（头孢唑林或万古霉素）预防PJI的疗效是否受患者合并症的影响。
利用一个包含1022例PJI的机构数据库，评估不同患者合并症对微生物谱的影响。为了研究围手术期抗生素（头孢唑林或万古霉素单药治疗）对PJI发生率的影响，确定了8575例初次全关节置换术，对PJI进行交叉匹配，并根据队列的合并症进行分析。比较每种合并症中每种抗生素的PJI发生率。
虽然没有合并症与革兰氏阳性感染或革兰氏阴性感染率增加相关，但转移性疾病（比值比[OR]5.71，P = .018）、充血性心力衰竭（OR 2.2，P = .010）、慢性肺病（OR 1.76，P = .015）和糖尿病（OR 1.66，P = .019）与抗生素耐药菌相关。然而，在按糖尿病、类风湿性关节炎、肝病和甲状腺功能减退分层时，头孢唑林和万古霉素单药治疗的PJI发生率没有差异。
本研究结果支持当前普遍抗生素预防方案的建议，而不是根据患者合并症个体化的抗生素治疗方案。
