Qi Yongjian, Yang Xu, Pan Zhengqi, Wang Hua, Chen Liaobin
Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, 430071, Wuhan, Wuchang District, China.
Orthopade. 2018 Mar;47(3):246-253. doi: 10.1007/s00132-017-3486-3.
Prophylactic antibiotic use prior to routine knee arthroscopy remains controversial. It is important to know whether antibiotics help decrease the surgical site infection (SSI) rate. Our aims were to assess the efficacy of antibiotic prophylaxis in preventing SSI and to identify risk factors for SSI following routine knee arthroscopy without an implant.
A retrospective study was conducted using the electronic medical records at the authors' hospital to identify patients that underwent routine knee arthroscopy without an implant between October 2010 and October 2016. Data on demographics, clinical characteristics and antibiotic administration were extracted. Arthroscopic diagnosis, debridement, partial or complete meniscectomy, arthroscopic shaving and microfracture, removal of loose bodies, synovectomy and lateral retinacular release were included. Complex knee arthroscopy with an implant was excluded. Patients were divided into evaluation (with prophylactic antibiotics) and control (no antibiotic treatment) groups. Continuous variables between groups were compared using the Student's t-test. Data were analyzed using the Chi-squared test for percentages between groups. Multivariate logistic regression was used to identify independent risk factors of SSI.
Of 1326 patients, 614 (46.3%) received prophylactic antibiotics, while 712 (53.7%) did not. There were seven (0.53%) SSIs. The SSI rate did not differ significantly between patients receiving antibiotics (0.49%, three) and those not (0.56%, four). Five patients (0.37%) had superficial infections, two (0.33%) were in the prophylactic antibiotic group and three (0.42%) were in the other group. Deep infections occurred in two patients (0.15%), one (0.16%) in the prophylactic antibiotic group and one (0.14%) in the other group. The difference between the two groups was not statistically significant (P = 1.0). Age over 50 years was associated with an increased risk of SSI (relative ratio [RR] = 1.469, 95% confidence interval [CI] 1.09-2.13, P = 0.009).
Prophylactic antibiotic use in routine knee arthroscopy without an implant may not be necessary. Age over 50 years was associated with an increased risk of SSI.
在常规膝关节镜检查前预防性使用抗生素仍存在争议。了解抗生素是否有助于降低手术部位感染（SSI）率很重要。我们的目的是评估抗生素预防在预防SSI中的疗效，并确定无植入物的常规膝关节镜检查后发生SSI的危险因素。
采用回顾性研究，利用作者所在医院的电子病历，确定2010年10月至2016年10月期间接受无植入物常规膝关节镜检查的患者。提取人口统计学、临床特征和抗生素使用的数据。包括关节镜诊断、清创、部分或完全半月板切除术、关节镜刨削和微骨折、取出游离体、滑膜切除术和外侧支持带松解术。排除有植入物的复杂膝关节镜检查。患者分为评估组（使用预防性抗生素）和对照组（未使用抗生素治疗）。组间连续变量采用Student t检验进行比较。数据采用卡方检验分析组间百分比。多因素logistic回归用于确定SSI的独立危险因素。
1326例患者中，614例（46.3%）接受了预防性抗生素治疗，712例（53.7%）未接受。有7例（0.53%）发生SSI。接受抗生素治疗的患者（0.49%，3例）和未接受抗生素治疗的患者（0.56%，4例）的SSI发生率无显著差异。5例患者（0.37%）发生浅表感染，预防性抗生素组2例（0.33%），另一组3例（0.42%）。2例患者（0.15%）发生深部感染，预防性抗生素组1例（0.16%），另一组1例（0.14%）。两组之间的差异无统计学意义（P = 1.0）。50岁以上患者发生SSI的风险增加（相对比[RR]=1.469，95%置信区间[CI]1.09 - 2.13，P = 0.009）。
在无植入物的常规膝关节镜检查中，预防性使用抗生素可能没有必要。50岁以上患者发生SSI的风险增加。
