Mercy Internal Medicine Service, Trinity Health of New England, 271 Carew St., Springfield, MA, 01104, USA.
Department of Orthopedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Fuyang, Anhui, China.
Dig Dis Sci. 2022 Dec;67(12):5562-5570. doi: 10.1007/s10620-022-07475-y. Epub 2022 Apr 6.
Current guidelines suggest antibiotics prophylaxis is not necessary for patients with orthopedic prosthetics undergoing gastrointestinal endoscopy. Clinical evidence to support this recommendation is lacking.
To analyze the association between inpatient gastrointestinal endoscopy and prosthetic joint infection (PJI) in patients with a recent arthroplasty.
We included patients admitted from July to October of each calendar year (index admissions) who had an arthroplasty in the same calendar year prior to the index admission. We followed the occurrence of PJI for 60 days after the index admission. Only admissions from July to October were chosen as index admissions, and the follow-up period was limited to 60 days because the database structure prohibits the analysis of events in different calendar years. We compared the rate of 60-day PJI between those who had gastrointestinal endoscopy on index admissions to those who had not. We excluded patients aged less than 18 years, who died on index admission, or had any infection in the same calendar year before or during the index admission.
Of 1,831,218 patients with arthroplasty, 88,345 met the inclusion criteria, out of which 5,855 had gastrointestinal endoscopy. The rate of 60-day PJI in those who had endoscopy was 0.23%, and in those who had not was 0.52% (P < 0.001). EGD without excision (adjusted odds ratio [95% confidence interval]: 0.20 [0.03-1.42], P = 0.107), EGD with excision (0.58 [0.21-1.60], P = 0.295), colonoscopy without excision (0.43 [0.11-1.72], P = 0.233), colonoscopy with excision (0.31 [0.04-2.21], P = 0.241), and PEG/PEJ (0.38 [0.05-2.71], P = 0.337) were not associated with risk of 60-day PJI. We found no PJI cases in patients underwent esophageal dilation, ERCP, and EUS with FNA.
Gastrointestinal endoscopy in hospitalized patients with a recent previous arthroplasty is not associated with an increased risk of 60-day prosthetic joint infection.
目前的指南建议，对于接受胃肠内镜检查的骨科假体患者，不需要预防性使用抗生素。缺乏支持这一建议的临床证据。
分析近期关节置换术后住院患者行胃肠内镜检查与人工关节感染（PJI）之间的关系。
我们纳入了每个日历年内 7 月至 10 月入院（索引入院）且在索引入院前同一日历年内进行过关节置换的患者。我们随访了索引入院后 60 天内 PJI 的发生情况。仅选择 7 月至 10 月作为索引入院，随访期限制为 60 天，因为数据库结构禁止分析不同日历年内的事件。我们比较了索引入院时行胃肠内镜检查和未行胃肠内镜检查患者的 60 天 PJI 发生率。排除年龄小于 18 岁、索引入院时死亡或索引入院前或期间同一日历年内有任何感染的患者。
在 1831218 例接受关节置换术的患者中，有 88345 例符合纳入标准，其中 5855 例行胃肠内镜检查。行内镜检查患者的 60 天 PJI 发生率为 0.23%，未行内镜检查患者的发生率为 0.52%（P<0.001）。未行内镜下切除术（调整后的比值比[95%置信区间]：0.20[0.03-1.42]，P=0.107）、行内镜下切除术（0.58[0.21-1.60]，P=0.295）、未行内镜下切除术（0.43[0.11-1.72]，P=0.233）、行内镜下切除术（0.31[0.04-2.21]，P=0.241）和 PEG/PEJ（0.38[0.05-2.71]，P=0.337）与 60 天 PJI 风险无关。我们发现行食管扩张术、ERCP 和 EUS 加 FNA 的患者无一例发生 PJI。
近期行关节置换术的住院患者行胃肠内镜检查与 60 天内人工关节感染的风险增加无关。
