Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia.
Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Pharmacoepidemiol Drug Saf. 2023 Feb;32(2):238-247. doi: 10.1002/pds.5522. Epub 2022 Sep 7.
Infection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision.
This retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n = 102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n = 3156) and primary THR with a subsequent revision for PJI (n = 520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR.
Prior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group.
Ongoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.
感染是关节置换术后的主要并发症。然而，关于初次关节置换术后抗生素的使用以及随着后续翻修手术而发生的变化，数据很少。本研究旨在检查因感染而接受翻修、因其他原因而接受翻修和未接受翻修的髋关节置换术后患者术前和术后抗生素使用率的变化。
本回顾性队列研究使用了澳大利亚矫形协会国家关节置换登记处和澳大利亚政府药品福利计划的相关数据。如果患者在 2002 年至 2017 年间在私立医院因骨关节炎接受全髋关节置换术（THR），则将其纳入研究。共检查了三组患者：初次 THR 且无后续翻修（n=102577）、初次 THR 后因非假体周围关节感染（PJI）以外的原因进行翻修（n=3156）和初次 THR 后因 PJI 进行翻修（n=520）。在 THR 术前和术后 2 年内，计算了每月抗生素使用率和 95%置信区间（CI）的优势比（PRR）。
初次 THR 前，抗生素使用率为 9%-10%。初次 THR 后，因 PJI 而接受翻修的患者（PRR 1.69，95%CI 1.60-1.79）与未接受翻修的患者相比，抗生素使用率较高，而因感染以外的原因而接受翻修的患者（PRR 0.96，95%CI 0.93-0.98）的使用率较低。对于因 PJI 而接受翻修的患者，术后翻修手术的抗生素使用率是因其他原因而接受翻修的两倍（PRR 2.16，95%CI 2.08-2.23）。与未接受翻修的患者相比，术后 0-2 周内因 PJI 而接受翻修的患者使用了包括万古霉素、氟氯西林和头孢唑林在内的注射用抗生素，但因其他原因而接受翻修的患者则没有。
初次手术后持续使用抗生素可能是 THR 出现问题的早期信号，应促使初级保健医生将患者转介给专家进行进一步的适当检查和治疗。
