Geller Jeffrey A, Cunn Gregory, Herschmiller Thomas, Murtaugh Taylor, Chen Antonia
Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Medical Center at New York Presbyterian Hospital, New York, New York.
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Arthroplasty. 2017 Oct;32(10):3120-3125. doi: 10.1016/j.arth.2017.04.054. Epub 2017 May 4.
Scarce literature exists regarding risk factors associated with postoperative acute kidney injury (AKI) after first-stage revision procedures. The purpose of this study was to determine risk factors for AKI and the efficacy of intra-articular antibiotics in infection eradication.
We retrospectively identified 247 patients who underwent a 2-stage revision procedure for the treatment of hip or knee periprosthetic joint infection. We applied previously published diagnostic criteria for AKI to determine its incidence and risk factors for its development.
A 26% incidence of AKI was found after first-stage joint revision for infection. Higher body mass index (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; P = .02), lower baseline hemoglobin level (OR, 0.70; 95% CI, 0.51-0.96; P = .03), and existence of a comorbid condition (OR, 2.67; 95% CI, 1.26-5.64; P = .01) were significant risk factors for AKI. Neither a higher dose of vancomycin (OR, 0.99; 95% CI, 0.88-1.11; P = .83) nor tobramycin (OR, 0.89; 95% CI, 0.77-1.04; P = .15) used in the cement spacer increased the risk of AKI. Each unit increase in vancomycin dose in the cement spacer decreased the odds of failing to clear the infection at 1 and 2 years by a factor of 0.82 (95% CI, 0.70-0.95; P = .01).
AKI after first-stage revision procedures for periprosthetic joint infection occurs more commonly than previously reported. Patients with identified risk factors should be managed carefully with attention paid to hemoglobin levels, to avoid AKI after this procedure. Further research is needed to determine the optimal local antibiotic type and dosing to maximize infection clearance and minimize potential side effects.
关于一期翻修手术后与术后急性肾损伤（AKI）相关的危险因素的文献较少。本研究的目的是确定AKI的危险因素以及关节内抗生素在根除感染方面的疗效。
我们回顾性地确定了247例行两阶段翻修手术治疗髋或膝关节假体周围感染的患者。我们应用先前发表的AKI诊断标准来确定其发生率及其发生的危险因素。
一期关节翻修治疗感染后，AKI的发生率为26%。较高的体重指数（优势比[OR]，1.07；95%置信区间[CI]，1.01 - 1.13；P = .02）、较低的基线血红蛋白水平（OR，0.70；95%CI，0.51 - 0.96；P = .03）以及存在合并症（OR，2.67；95%CI，1.26 - 5.64；P = .01）是AKI的显著危险因素。骨水泥间隔器中使用较高剂量的万古霉素（OR，0.99；95%CI，0.88 - 1.11；P = .83）和妥布霉素（OR，0.89；95%CI，0.77 - 1.04；P = .15）均未增加AKI的风险。骨水泥间隔器中万古霉素剂量每增加一个单位，1年和2年时未能清除感染的几率降低0.82倍（95%CI，0.70 - 0.95；P = .01）。
假体周围关节感染一期翻修手术后AKI的发生比先前报道的更为常见。对于已确定有危险因素的患者，应谨慎管理，关注血红蛋白水平，以避免该手术后发生AKI。需要进一步研究以确定最佳的局部抗生素类型和剂量，以最大限度地清除感染并最小化潜在副作用。
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