Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5255-5260. doi: 10.1007/s00402-022-04744-3. Epub 2022 Dec 28.
First-generation cephalosporins are used as antibiotic prophylaxis in total joint arthroplasty patients. However, this regimen does not address Gram-negative bacteria causing periprosthetic joint infection (PJI). Previous studies have suggested that the addition of an aminoglycoside as antibiotic prophylaxis in THA reduces surgical site infection (SSI), and less is known on its effect in TKA. This study aimed to investigate if the addition of a single-dose gentamicin, administered pre-operatively, is associated with lower rates of infection in TKA patients.
This is a retrospective study of patients who underwent primary TKA as treatment for osteoarthritis between January 2011 and April 2021, with a minimum 1-year follow-up. The mean age was 69.9 (± 9.8), the mean BMI was 29.7 (± 5.5), and most patients had American Society of Anaesthesiology (ASA) score of 2-3 (92.9%). Patients were stratified based on the peri-operative antibiotic prophylaxis they received: cefazolin with addition of gentamicin (case group) or cefazolin (control group). Our primary study endpoints were rates of PJI and SSI, which were compared between groups using the chi-square test. Statistical significance was set as p < 0.05.
The final study population consisted of 1590 patients, 1008 (63.4%) in the control group and 582 (36.6%) patients in the case group. The total infection rate for patients that received gentamicin dropped by 34%; however, this finding did not reach statistical significance (1.3% (control) vs. 0.86% (case), p = 0.43). The same drop was seen after subdivision of infections to PJI (0.5% vs. 0.34%, 32% drop, p = 0.66) and SSI (0.8% vs. 0.52%, 35% drop, p = 0.52).
A single dose of gentamicin administered pre-operatively to a standard antibiotic prophylaxis was not associated with a statistically significant lower rate of PJI. Although the difference in infection rate did not reach statistical significance, the current study noted a drop in the rate of infection by 1/3 in the gentamicin cohort. Further investigation to evaluate the potential benefit of adding gentamicin to a peri-operative antibiotic regimen is warranted.
第一代头孢菌素被用作全关节置换术患者的抗生素预防用药。然而，这种方案并不能解决引起假体周围关节感染（PJI）的革兰氏阴性菌。先前的研究表明，在初次全髋关节置换术（THA）中添加氨基糖苷类抗生素作为抗生素预防用药可降低手术部位感染（SSI）的发生率，而在初次全膝关节置换术（TKA）中其效果知之甚少。本研究旨在探讨术前单次给予庆大霉素是否与 TKA 患者的感染率降低有关。
这是一项回顾性研究，纳入 2011 年 1 月至 2021 年 4 月期间因骨关节炎接受初次 TKA 治疗的患者，所有患者均随访至少 1 年。患者的平均年龄为 69.9（±9.8）岁，平均 BMI 为 29.7（±5.5）kg/m²，大多数患者的美国麻醉医师协会（ASA）评分在 2-3 分（92.9%）。根据围手术期抗生素预防用药的不同，患者分为头孢唑林加用庆大霉素（病例组）和头孢唑林（对照组）。本研究的主要终点是 PJI 和 SSI 的发生率，采用卡方检验比较两组之间的差异。统计学意义设定为 p<0.05。
最终研究人群包括 1590 例患者，其中对照组 1008 例（63.4%），病例组 582 例（36.6%）。接受庆大霉素治疗的患者总感染率下降了 34%；但这一结果没有统计学意义（对照组为 1.3%，病例组为 0.86%，p=0.43）。在将感染细分为 PJI（0.5%对 0.34%，下降 32%，p=0.66）和 SSI（0.8%对 0.52%，下降 35%，p=0.52）后，也观察到同样的下降。
术前单次给予庆大霉素与标准抗生素预防用药相比，并不显著降低 PJI 的发生率。尽管感染率的差异没有达到统计学意义，但本研究注意到庆大霉素组的感染率下降了 1/3。需要进一步研究评估在围手术期抗生素方案中添加庆大霉素的潜在获益。
