From the Department of Orthopedic Surgery, Southern California Permanente Medical Group, Kaiser Permanente, Anaheim, CA (Dr. Yian), Surgical Outcomes and Analysis, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, CA (Dr. Chan, Mr. Burfeind), the Southern California Permanente Medical Group, Kaiser Permanente, Harbor City, CA (Dr. Navarro), the Southern California Permanente Medical Group, Kaiser Permanente, San Diego, CA (Dr. Singh), and the Department of Orthopedic Surgery, The Permanente Medical Group, Kaiser Permanente, Sacramento, CA (Dr. Dillon).
J Am Acad Orthop Surg. 2020 Mar 15;28(6):e270-e276. doi: 10.5435/JAAOS-D-19-00168.
This study determines whether infection rates differ between prophylactic antibiotic use for patients with or without penicillin allergy before shoulder arthroplasty surgery.
Seven thousand one hundred forty primary shoulder arthroplasties operated between 2005 and 2016 were identified. We compared deep surgical site infection risk of patients who received perioperative vancomycin alone (6.2%, N = 444) or clindamycin alone (7.1%, N = 508) for penicillin allergy versus patients who received cefazolin alone without penicillin allergy (86.7%, N = 6,188).
Seventy deep infections (1.2% 5-year cumulative incidence) were observed. The most common organism was Cutibacterium acnes (39.4%, N = 27). Compared with patients treated with cefazolin, infection risk was not different for those treated with vancomycin (hazard ratio = 1.17, 95% confidence interval 0.42 to 3.30, P = 0.8), but a higher risk of infection was identified for those treated with clindamycin alone (hazard ratio = 3.45, 95% confidence interval 1.84 to 6.47, P < 0.001).
A higher risk of postoperative infection is found after prophylactic use of intravenous clindamycin antibiotic after shoulder arthroplasty. Vancomycin is preferred over clindamycin for patients with penicillin allergy.
III, retrospective cohort study.
本研究旨在确定在肩关节置换术前对青霉素过敏或无青霉素过敏的患者预防性使用抗生素后，感染率是否存在差异。
确定了 2005 年至 2016 年间进行的 7140 例原发性肩关节置换术。我们比较了因青霉素过敏而接受围手术期单独万古霉素（6.2%，N=444）或单独克林霉素（7.1%，N=508）治疗，以及无青霉素过敏而接受头孢唑林单独治疗（86.7%，N=6188）的患者的深部手术部位感染风险。
观察到 70 例深部感染（5 年累计发生率为 1.2%）。最常见的病原体是痤疮丙酸杆菌（39.4%，N=27）。与接受头孢唑林治疗的患者相比，接受万古霉素治疗的患者感染风险无差异（危险比=1.17，95%置信区间 0.42 至 3.30，P=0.8），但单独接受克林霉素治疗的患者感染风险更高（危险比=3.45，95%置信区间 1.84 至 6.47，P<0.001）。
在肩关节置换术后预防性使用静脉注射克林霉素抗生素后，发现术后感染的风险更高。对于青霉素过敏的患者，万古霉素优于克林霉素。
III，回顾性队列研究。
