Miltenberg Benjamin, Ludwick Leanne, Masood Raisa, Menendez Mariano E, Moverman Michael A, Pagani Nicholas R, Puzzitiello Richard N, Smith Eric L
Tufts University School of Medicine, Boston, Massachusetts.
Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts.
J Arthroplasty. 2023 Apr;38(4):769-774. doi: 10.1016/j.arth.2022.10.023. Epub 2022 Oct 22.
Intraosseous regional administration (IORA) of antibiotics after tourniquet inflation has recently been introduced as a technique to deliver antibiotics directly to the surgical site among patients undergoing total knee arthroplasty (TKA).
PubMed and Embase were queried for studies reporting on IORA for perioperative prophylaxis during TKA. Primary outcome measures were local tissue antibiotic concentrations and rates of prosthetic joint infection (PJI). Eight studies were included for analysis. Four studies (all randomized controlled trials) compared local tissue concentrations between patients receiving IORA and intravenous (IV) antibiotics. Six studies assessed the rate of PJI among patients receiving IORA versus IV antibiotics.
All studies found a statistically significant increase in antibiotic concentration in femoral bone and fat samples in patients who were treated with IORA (44.04 μg/g [fat] and 49.3 μg/g [bone] following 500 mg of intraosseous vancomycin) versus IV (3.5 μg/g [fat] and 5.2 μg/g [bone] following 1 g IV of vancomycin). The two studies powered to determine differences in PJI rates found a statistically significant decrease in the rate of PJI among patients receiving IORA versus IV antibiotics. The incidence of PJI in patients treated with IORA and IV antibiotics across all studies was 0.3 and 1.1%, respectively.
Perioperative IORA of antibiotics in TKA provides local tissue concentrations of antibiotics that are on average 10 times higher than IV administration alone. Although more adequately powered investigations are necessary to determine the effectiveness of IORA in reducing PJI rates, adoption of IORA should be considered in high-risk patients where elevated tissue antibiotic concentrations would be of a maximum benefit.
在止血带充气后进行抗生素骨内区域给药（IORA），最近已作为一种在全膝关节置换术（TKA）患者中将抗生素直接输送到手术部位的技术被引入。
检索PubMed和Embase数据库，查找关于TKA围手术期预防使用IORA的研究。主要观察指标为局部组织抗生素浓度和人工关节感染（PJI）发生率。纳入八项研究进行分析。四项研究（均为随机对照试验）比较了接受IORA和静脉注射（IV）抗生素患者的局部组织浓度。六项研究评估了接受IORA与IV抗生素患者的PJI发生率。
所有研究均发现，与静脉注射相比，接受IORA治疗的患者股骨骨和脂肪样本中的抗生素浓度有统计学显著升高（骨内注射500 mg万古霉素后，脂肪中为44.04 μg/g，骨中为49.3 μg/g），而静脉注射1 g万古霉素后，脂肪中为3.5 μg/g，骨中为5.2 μg/g。两项有能力确定PJI发生率差异的研究发现，接受IORA的患者与接受IV抗生素的患者相比，PJI发生率有统计学显著降低。在所有研究中，接受IORA和IV抗生素治疗的患者PJI发生率分别为0.3%和1.1%。
TKA围手术期使用抗生素进行IORA可使局部组织抗生素浓度平均比单纯静脉注射高10倍。尽管需要更充分有力的研究来确定IORA在降低PJI发生率方面的有效性，但对于组织抗生素浓度升高将带来最大益处的高危患者，应考虑采用IORA。
