关节假体周围感染的病原体谱是否会随着局部万古霉素粉末和低浓度聚维酮碘冲洗方案而改变？
Does the Organism Profile of Periprosthetic Joint Infections Change With a Topical Vancomycin Powder and Dilute Povidone-Iodine Lavage Protocol?
机构信息
Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
出版信息
J Arthroplasty. 2021 Jul;36(7S):S314-S319. doi: 10.1016/j.arth.2020.12.036. Epub 2020 Dec 26.
BACKGROUND
While vancomycin powder and dilute povidone-iodine (VIP) is associated with fewer total joint arthroplasty (TJA) periprosthetic joint infections (PJI), its effect on PJI organism profiles is unclear. This study evaluates primary TJA PJI organism profiles before and after the implementation of a VIP protocol.
METHODS
In total, 18,299 primary TJAs performed at a university-affiliated, not-for-profit orthopedic hospital from before (1/2012-12/2013) and after (1/2016-12/2019) a VIP protocol was initiated were reviewed to identify deep PJIs that occurred within 90 days of the index arthroplasty as defined by the Musculoskeletal Infection Society guidelines. Demographics, overall organism incidence (n/TJAs), and relative organism incidence (n/PJIs) from the two cohorts were compared.
RESULTS
In total, 103 TJA PJIs were identified (pre-VIP: 32/3982; VIP: 71/14,317). Following the introduction of VIP, the overall and relative incidence of coagulase-negative staphylococcal TJA PJIs significantly decreased (overall: 0.20% to 0.04%, P = .004; relative: 25.00% to 8.45%, P = .031). In response, the relative incidence of MSSA TJA PJIs significantly increased (18.75% to 40.85%, P = .042). Broken down by arthroplasty type, VIP was associated with a significantly lower overall incidence of coagulase-negative staphylococcal total knee arthroplasty (TKA) PJIs (0.27% to 0.06%, P = .015), a significantly lower overall incidence of MRSA TKA PJIs (0.18% to 0.03%, P = .031), and a nonsignificant decrease in the overall incidence of gram-negative TKA PJIs (0.18% to 0.04%, P = .059). No organism profile changes were found in total hip arthroplasty PJIs.
CONCLUSION
VIP is not associated with more difficult to treat primary TJA PJIs. While promising, these findings require a prospective randomized controlled trial for confirmation.
LEVEL OF EVIDENCE
Level III, Retrospective cohort study.
背景
万古霉素粉末和稀碘伏（VIP）与更少的全关节置换术（TJA）假体周围关节感染（PJI）相关，但它对 PJI 病原体谱的影响尚不清楚。本研究评估了 VIP 方案实施前后原发性 TJA PJI 病原体谱。
方法
共回顾了一家大学附属非营利性骨科医院的 18299 例原发性 TJA，这些 TJA 分别在 VIP 方案实施前（2012 年 1 月至 2013 年 12 月）和实施后（2016 年 1 月至 2019 年 12 月）进行，以确定符合肌骨骼感染学会指南定义的在索引关节置换术后 90 天内发生的深部 PJI。比较了两个队列的人口统计学资料、总体病原体发生率（n/TJAs）和相对病原体发生率（n/PJIs）。
结果
共发现 103 例 TJA PJI（VIP 前：32/3982；VIP：71/14317）。在 VIP 引入后，凝固酶阴性葡萄球菌 TJA PJI 的总体和相对发生率显著降低（总体：0.20%降至 0.04%，P=0.004；相对：25.00%降至 8.45%，P=0.031）。相应地，MSSA TJA PJI 的相对发生率显著增加（18.75%升至 40.85%，P=0.042）。按关节置换类型细分，VIP 与凝固酶阴性葡萄球菌全膝关节置换术（TKA）PJI 的总体发生率显著降低（0.27%降至 0.06%，P=0.015）、MRSA TKA PJI 的总体发生率显著降低（0.18%降至 0.03%，P=0.031）以及革兰氏阴性 TKA PJI 的总体发生率降低（0.18%降至 0.04%，P=0.059）均无显著变化。全髋关节置换术 PJI 无病原体谱变化。
结论
VIP 与更难治疗的原发性 TJA PJI 无关。虽然有希望，但这些发现需要前瞻性随机对照试验来证实。
证据水平
III 级，回顾性队列研究。
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