Dutton Lauren K, Hinchcliff Katharine M, Logli Anthony L, Mallett Katherine E, Suh Gina A, Rizzo Marco
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
JB JS Open Access. 2022 Mar 24;7(1). doi: 10.2106/JBJS.OA.21.00084. eCollection 2022 Jan-Mar.
When treating upper-extremity infections, clinicians frequently must decide whether to initiate antibiotics or delay them with the goal of optimizing culture yield at the time of surgical debridement. The purpose of this study was to determine whether the administration of preoperative antibiotics affects intraoperative culture yield and whether there is a "safe" interval prior to culture acquisition within which antibiotics can be administered without affecting culture yield.
We conducted a retrospective review of 470 consecutive patients who underwent debridement for a presumed acute infection of the hand, wrist, or forearm at a single tertiary care center between January 2015 and May 2020. Data including patient demographics, mechanism of infection and affected body part(s), and details of antibiotic administration, including type and timing with respect to culture acquisition, were collected.
Three hundred and forty-one patients (73%) received preoperative antibiotics prior to debridement and culture acquisition. The rate of positive cultures among patients who received preoperative antibiotics was 81% compared with 95% among patients who did not receive preoperative antibiotics (p < 0.01; odds ratio, 4.73). Even a single dose of antibiotics imparted a significantly increased risk of obtaining negative intraoperative cultures, and an incremental increase in the likelihood of obtaining negative cultures was seen with each preoperative dose given up to 7 doses. We did not identify a "safe" interval of time between antibiotic administration and culture acquisition such that culture yield was not affected.
Patients who received preoperative antibiotics for the treatment of upper-extremity infections were approximately 5 times more likely to have negative cultures at the time of debridement than those who did not receive preoperative antibiotics. This effect persisted regardless of the number of doses given or the interval between antibiotic administration and culture acquisition.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
在治疗上肢感染时，临床医生常常必须决定是立即使用抗生素还是延迟使用，以期在手术清创时优化培养结果。本研究的目的是确定术前使用抗生素是否会影响术中培养结果，以及在获取培养样本前是否存在一个“安全”时间段，在此期间使用抗生素不会影响培养结果。
我们对2015年1月至2020年5月在一家三级医疗中心因手部、腕部或前臂疑似急性感染而接受清创术的470例连续患者进行了回顾性研究。收集的数据包括患者人口统计学资料、感染机制和受累身体部位，以及抗生素使用细节，包括类型和与获取培养样本相关的时间。
341例患者（73%）在清创和获取培养样本前接受了术前抗生素治疗。接受术前抗生素治疗的患者中培养结果为阳性的比例为81%，而未接受术前抗生素治疗的患者中这一比例为95%（p<0.01；优势比为4.73）。即使仅使用一剂抗生素，获得术中阴性培养结果的风险也会显著增加，并且在给予多达7剂术前抗生素的情况下，每增加一剂，获得阴性培养结果的可能性就会增加。我们未发现抗生素使用与获取培养样本之间存在一个不影响培养结果的“安全”时间段。
因上肢感染接受术前抗生素治疗的患者在清创时培养结果为阴性的可能性是未接受术前抗生素治疗患者的约5倍。无论给予的剂量数量或抗生素使用与获取培养样本之间的间隔如何，这种影响都持续存在。
预后水平III。有关证据水平的完整描述，请参阅作者须知。
