Wouthuyzen-Bakker Marjan, Tornero Eduard, Claret Guillem, Bosch Jordi, Martinez-Pastor Juan Carlos, Combalia Andreu, Soriano Alex
Department of Internal Medicine/Infectious diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
J Arthroplasty. 2017 Sep;32(9):2829-2833. doi: 10.1016/j.arth.2017.03.064. Epub 2017 Apr 6.
A significant amount of patients undergoing revision surgery of a prosthetic joint turn out to have an infection. Withholding preoperative antibiotic prophylaxis in these patients to optimize culture yield during revision surgery remains a matter of debate. The aim of our study was to determine (1) the rate of positive intraoperative cultures with or without preoperative antibiotic prophylaxis and (2) the incidence of a prosthetic joint infection (PJI) during the follow-up in the 2 groups.
Medical files of patients in whom preoperative antibiotic prophylaxis was withheld until culture samples were taken (2007-2010, n = 284) and in whom antibiotic prophylaxis was given during the induction of anesthesia (2010-2013, n = 141) were retrospectively reviewed.
The percentage of ≥1 positive cultures was the same in the group without (26%) and with preoperative prophylaxis (27%; P value, .7). PJI was diagnosed during revision surgery according to the Musculoskeletal Infection Society criteria in 6.7% patients not receiving preoperative prophylaxis and in 7.0% receiving it (P value, .79). We found no important differences in the type of microorganisms that were isolated in both groups. During a 3-month follow-up, an early PJI developed in patients undergoing total revision surgery in 6.4% of the nonpreoperative prophylaxis group vs 1.6% in the preoperative prophylaxis group (P value, .1).
Preoperative antibiotic prophylaxis does not reduce culture yield in patients undergoing knee revision surgery. Our data show a trend toward a higher PJI rate in the postoperative period of total revision surgery when preoperative prophylaxis is withheld.
大量接受人工关节翻修手术的患者被证实存在感染。对于这些患者，在翻修手术期间停用术前抗生素预防措施以优化培养结果仍存在争议。我们研究的目的是确定：（1）有无术前抗生素预防措施时术中培养阳性率；（2）两组患者随访期间人工关节感染（PJI）的发生率。
回顾性分析2007 - 2010年术前未使用抗生素预防措施直至采集培养样本的患者（n = 284）以及2010 - 2013年麻醉诱导期使用抗生素预防措施的患者（n = 141）的病历。
未进行术前预防措施组和进行术前预防措施组中≥1次培养阳性的百分比相同（分别为26%和27%；P值为0.7）。根据肌肉骨骼感染学会标准，在翻修手术期间诊断为PJI的患者中，未接受术前预防措施的患者为6.7%，接受术前预防措施的患者为7.0%（P值为0.79）。我们发现两组分离出的微生物类型没有显著差异。在3个月的随访中，全膝关节翻修手术患者中，未进行术前预防措施组早期PJI发生率为6.4%，术前预防措施组为1.6%（P值为0.1）。
术前抗生素预防措施不会降低膝关节翻修手术患者的培养阳性率。我们的数据显示，在全膝关节翻修手术的术后阶段，不进行术前预防措施时PJI发生率有升高趋势。
