Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
J Knee Surg. 2022 Sep;35(11):1209-1213. doi: 10.1055/s-0040-1722350. Epub 2021 Jan 22.
We performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including "on-time" dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's -test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with "on time" vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, < 0.01). "On Time" vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI < 45 kg/m (0.5 vs. 2.6%, < 0.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9 kg/m ( < 0.01). No difference was noted for patients with a BMI ≥ 45 kg/m (3.3 vs. 2.6%, = 0.71). There were no infections in 150 TKA patients with a normal BMI (18-25 kg/m) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18-25 kg/m) or for higher risk patients with a BMI > 45 kg/m.
我们进行这项研究是为了评估包括“及时”双联抗生素预防在内的多模式全膝关节置换术假体关节感染（TKA-PJI）预防的有效性，以及体重指数（BMI）对预防效果的影响。在获得机构审查委员会批准后，我们评估了 1802 例接受头孢唑林单独或头孢唑林联合万古霉素预防 TKA-PJI 的原发性 TKA（1496 例患者）。进行了详细的图表审查，以确定患者的人口统计学特征（年龄、性别、BMI、美国麻醉医师协会评分）、抗生素选择、万古霉素给药时间和 1 年 PJI 发生率。使用双侧学生 t 检验或 Fisher 确切检验进行统计评估。接受“及时”万古霉素输注双联抗生素预防（CVt 组）的患者感染率明显低于其他 TKA 患者（0.8% vs. 2.7%，<0.01）。对于 BMI<45kg/m 的患者，“及时”万古霉素给药与 TKA-PJI 发生率较低相关（0.5% vs. 2.6%，<0.01），120 例 BMI 为 40 至 44.9kg/m 的 TKA 患者中无一例感染（<0.01）。对于 BMI≥45kg/m 的患者，差异无统计学意义（3.3% vs. 2.6%，=0.71）。在任何 PJI 预防治疗组中，150 例 BMI 正常（18-25kg/m）的 TKA 患者均无感染。采用双联抗生素预防方法可成功降低超重和中度肥胖患者的 TKA-PJI 发生率。该方法似乎不会影响 BMI 正常（18-25kg/m）的低风险患者或 BMI>45kg/m 的高风险患者的结局。
