开放性骨折患者使用哌拉西林-他唑巴坦进行抗生素预防后发生急性肾损伤及骨折相关感染的风险

McMurtrie Thompson, Cone Ryan J, Mihas Alexander K, Patch David A, McGwin Gerald, Spitler Clay A

Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and.

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.

J Orthop Trauma. 2023 Feb 1;37(2):e73-e79. doi: 10.1097/BOT.0000000000002473.

OBJECTIVES

To evaluate the effects of prophylactic piperacillin-tazobactam (PT) on inpatient acute kidney injury (AKI) and fracture-related infection (FRI) in patients with open fractures.

SETTING

The study was conducted at a Level 1 trauma center.

PATIENTS

We reviewed 358 Gustilo-Anderson type II and III open fractures at our institution from January 2013 to December 2017.

INTERVENTION

Administration of PT (the PT group) or antibiotics other than PT (the historical control group) during the first 48 hours of arrival for open fracture antibiotic prophylaxis.

MAIN OUTCOME MEASUREMENTS

The main outcome measurements were rates of inpatient AKI and FRI within six months after definitive fixation.

RESULTS

There were 176 patients in the PT group and 182 patients in the historical control group. The PT group had worse American Society of Anesthesiologists class ( P = 0.004) and injury severity scores ( P < 0.001), a higher average number of debridements before closure/coverage ( P = 0.043), and higher rates of gross soil contamination ( P = 0.049) and staged procedures ( P = 0.008) compared with the historical control group.There was no difference in the rate of AKI between the PT and historical control groups (5.7% vs. 2.7%, P = 0.166) nor when stratified by Gustilo-Anderson fracture classification (type II: 5.8% vs. 3.6%, P = 0.702; type III: 5.6% vs. 2.0%, P = 0.283). There was no significant difference in the rate of FRI between the PT and historical control groups (23.6% vs. 19.6%, P = 0.469).

CONCLUSION

The use of PT in prophylactic antimicrobial treatment in patients with Gustilo-Anderson type II and III open fractures does not increase the rate of AKI or FRI. We believe PT can be used as an effective monotherapy in these patients without an increased risk of renal injury, but future investigations are necessary.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的

评估预防性使用哌拉西林 - 他唑巴坦（PT）对开放性骨折患者住院期间急性肾损伤（AKI）和骨折相关感染（FRI）的影响。

背景

该研究在一家一级创伤中心进行。

患者

我们回顾了2013年1月至2017年12月在我院的358例Gustilo - Anderson II型和III型开放性骨折患者。

干预措施

在开放性骨折抗生素预防治疗的最初48小时内给予PT（PT组）或PT以外的抗生素（历史对照组）。

主要观察指标

主要观察指标为确定性固定后六个月内的住院AKI和FRI发生率。

结果

PT组有176例患者，历史对照组有182例患者。与历史对照组相比，PT组的美国麻醉医师协会分级更差（P = 0.004），损伤严重程度评分更高（P < 0.001），闭合/覆盖前的清创平均次数更多（P = 0.043），严重污染率更高（P = 0.049），分期手术率更高（P = 0.008）。PT组和历史对照组之间的AKI发生率没有差异（5.7%对2.7%，P = 0.166），按Gustilo - Anderson骨折分类分层时也无差异（II型：5.8%对3.6%，P = 0.702；III型：5.6%对2.0%，P = 0.283）。PT组和历史对照组之间的FRI发生率没有显著差异（23.6%对19.6%，P = 0.469）。