Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.
BMC Musculoskelet Disord. 2020 May 11;21(1):292. doi: 10.1186/s12891-020-03332-z.
One of the most common bacteria responsible for most Periprosthetic joint infection (PJI) is Propionibacterium acnes. Even though the rate of infections in patients undergoing total shoulder arthroplasty is increasing, effective diagnostic tests and the precautions taken during the surgery are not yet adequate. This systematic review aims to evaluate the effectiveness of antimicrobial prophylaxis in PJI in shoulder replacement and to provide health workers with the best approach to the use of antimicrobial agents based on currently available clinical evidence.
a systematic review of the literature was carried out in accordance with the PRISMA Statement. Studies concerning the effectiveness of antimicrobial prophylaxis in the prevention of PJI in patients undergoing shoulder replacement were included.
Seven studies were included in the final analysis because they were considered valid. A total of 3272 patients underwent a surgical procedure, most of which were males. The male population has a greater presence of hair, therefore a greater risk of P. acnes. in surface cultures. Patients were assessed at an average follow-up period of 20 months ranging from 9 weeks to 53 months.
The optimal perioperative antimicrobial regimen is controversial. The clinical guidelines recommend the use of only one antibiotic as prophylaxis but considering the increase in the rates of antibiotic-resistant infections, the question arises whether antibiotic prophylaxis should be extended for adequate coverage. Shoulder arthroplasty performed on the male population must be carefully checked after surgery for the possible presence of P. Acnes.
导致大多数假体周围关节感染（PJI）的最常见细菌之一是痤疮丙酸杆菌。尽管全肩关节置换术后感染的发生率正在增加，但有效的诊断测试和手术中的预防措施尚不完善。本系统评价旨在评估抗菌预防措施在肩置换术 PJI 中的有效性，并根据现有临床证据为卫生工作者提供使用抗菌药物的最佳方法。
按照 PRISMA 声明进行了系统的文献回顾。纳入了关于抗菌预防措施在预防肩置换术后 PJI 中的有效性的研究。
最终分析纳入了 7 项研究，因为它们被认为是有效的。共有 3272 名患者接受了手术，其中大多数为男性。男性人群毛发较多，因此在表面培养物中 P. acnes 的风险更大。患者在平均 20 个月的随访期内进行评估，随访时间从 9 周到 53 个月不等。
最佳围手术期抗菌方案存在争议。临床指南建议仅使用一种抗生素作为预防措施，但考虑到抗生素耐药性感染率的增加，是否应该延长抗生素预防措施以提供足够的覆盖范围，这一问题引起了争议。在男性人群中进行的肩关节置换术后，必须在手术后仔细检查是否存在 P. Acnes。
