Bruin Maarten M, Deijkers Ruud L M, Bus Michaël P A, van Elzakker Erika P M, Bazuin Roos, Nelissen Rob G, Pijls Bart G
Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands.
Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
J Clin Med. 2022 Mar 26;11(7):1842. doi: 10.3390/jcm11071842.
The perioperative use of certain medication may influence the risk of developing a periprosthetic joint infection (PJI). Inhaled corticosteroids (ICSs) and cardiovascular drugs are widely used against pulmonary and cardiovascular diseases. While oral corticosteroids and anticoagulants have been shown to increase the risk of developing PJI, this is not clear for ICSs. In contrast, some cardiovascular drugs, such as amlodipine, nifedipine and statins, have been documented to show an antimicrobial effect, suggesting a synergistic effect with antibiotics in the treatment of (multi-resistant) microorganisms. We performed a case-cohort study to assess the association between the occurrence of PJI after THA and the use of inhaled corticosteroids, anticoagulants, or previously mentioned cardiovascular agents. In a cohort of 5512 primary THAs, we identified 75 patients with a PJI (1.4%), and randomly selected 302 controls. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders (age, sex, smoking, and cardiovascular/pulmonary disease). We found ICS use (HR 2.6 [95% CI 1.1-5.9]), vitamin K antagonist use (HR 5.3 [95% CI 2.5-11]), and amlodipine use (HR 3.1 [95% CI 1.4-6.9]) to be associated with an increased risk of developing PJI after THA. The effect remained after correction for the mentioned possible confounders. The underlying diseases for which the medications are prescribed could also play a role in the mentioned association; we believe, however, that the usages of ICSs, vitamin K antagonists and amlodipine appear to be potential modifiable risk factors for PJI, and therefore have to be questioned during preoperative screening and consultation.
某些药物的围手术期使用可能会影响发生人工关节周围感染（PJI）的风险。吸入性糖皮质激素（ICSs）和心血管药物被广泛用于治疗肺部和心血管疾病。虽然口服糖皮质激素和抗凝剂已被证明会增加发生PJI的风险，但ICSs的情况尚不清楚。相比之下，一些心血管药物，如氨氯地平、硝苯地平和他汀类药物，已被证明具有抗菌作用，这表明它们在治疗（多重耐药）微生物方面与抗生素有协同作用。我们进行了一项病例队列研究，以评估全髋关节置换术（THA）后发生PJI与使用吸入性糖皮质激素、抗凝剂或上述心血管药物之间的关联。在一个包含5512例初次THA的队列中，我们确定了75例发生PJI的患者（1.4%），并随机选择了302例对照。采用加权Cox比例风险回归模型进行研究设计，并对潜在混杂因素（年龄、性别、吸烟以及心血管/肺部疾病）进行校正。我们发现，使用ICSs（风险比[HR] 2.6 [95%置信区间（CI）1.1 - 5.9]）、维生素K拮抗剂（HR 5.3 [95% CI 2.5 - 11]）和氨氯地平（HR 3.1 [95% CI 1.4 - 6.9]）与THA后发生PJI的风险增加相关。在校正上述可能的混杂因素后，该效应依然存在。开具这些药物所针对的基础疾病在上述关联中也可能起作用；然而，我们认为，ICSs、维生素K拮抗剂和氨氯地平的使用似乎是PJI潜在的可改变风险因素，因此在术前筛查和会诊期间必须予以关注。
