性别对保留假体清创、抗生素治疗人工关节感染结局的影响：系统评价和个体患者数据分析荟萃分析。
The Impact of Sex on the Outcomes of Prosthetic Joint Infection Treatment with Debridement, Antibiotics and Implant Retention: A Systematic Review and Individual Patient Data Meta-analysis.
机构信息
From the Department of Surgery, The University of Melbourne, Melbourne, Australia (A.L. Choong, Shadbolt, E. Choong, Spelman, P.F.M. Choong, Dowsey); Department of Orthopaedics and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain (Muñoz-Mahamud); Department of Internal Medicine, Hospital Universitario, Madrid, Spain (Lora-Tamayo); Department of Medicine, The University of Auckland, Auckland, New Zealand (Kim); Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Wouthuyzen-Bakker); Department of Orthopaedic Surgery, Mayo Clinic Arizona Phoenix, AZ (Spangehl); Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Chayakulkeeree); Department of Orthopaedic Surgery, University of Auckland, Auckland, New Zealand (Young); and Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia (P.F.M. Choong, Dowsey).
出版信息
J Am Acad Orthop Surg Glob Res Rev. 2022 Nov 9;6(11). doi: 10.5435/JAAOSGlobal-D-22-00102. eCollection 2022 Nov 1.
BACKGROUND
The influence of sex on the failure of débridement antibiotics and implant retention (DAIR) for treating prosthetic joint infection (PJI) is important for decision-making, patient counseling, and equitable health care. However, very few studies in the orthopaedic literature conduct sex-specific analyses.
AIM
The primary aim was to determine whether sex influences treatment success after DAIR.
METHODS
A systematic review and individual patient data (IPD) meta-analysis was conducted. MEDLINE (Ovid), EMBASE (Ovid), Web of Science, and Google Scholar were searched, and IPD was requested via e-mail. Patients who underwent DAIR after developing PJI within 12 months of a primary total hip or knee arthroplasty were included in the analysis. Treatment failure was defined by the Delphi International Consensus criteria. Adjusted odds ratios for treatment failure were calculated using a mixed-effects logistic regression.
RESULTS
The study collected and analyzed IPD of 1,116 patients from 21 cohorts. The odds of treatment failure were 29% lower in women (odds ratio, 0.71; 95% CI 0.54 to 0.017; P = 0.017), after adjusting for duration of symptoms >7 days and Staphylococcus aureus infection (methicillin-susceptible Staphylococcus aureus or any infection with S aureus). None of the 64 studies included in the systematic review conducted a sex-specific analysis.
CONCLUSION
For patients who developed a PJI within 1 year postsurgery, females have lower odds of DAIR failure than males. Other factors also have varying effects on outcome for men and women. It is essential to implement sex-specific analysis in orthopaedic research.
背景
性别对清创抗生素保留植入物（DAIR）治疗人工关节感染（PJI）的失败的影响对决策、患者咨询和公平的医疗保健很重要。然而，骨科文献中很少有研究进行性别特异性分析。
目的
主要目的是确定性别是否影响 DAIR 后的治疗成功率。
方法
进行了系统评价和个体患者数据（IPD）荟萃分析。检索 MEDLINE（Ovid）、EMBASE（Ovid）、Web of Science 和 Google Scholar，并通过电子邮件请求 IPD。分析纳入了在初次全髋关节或膝关节置换术后 12 个月内发生 PJI 后接受 DAIR 的患者。治疗失败的定义为 Delphi 国际共识标准。使用混合效应逻辑回归计算治疗失败的调整后优势比。
结果
该研究共收集并分析了来自 21 个队列的 1116 名患者的 IPD。调整 >7 天症状持续时间和金黄色葡萄球菌感染（耐甲氧西林金黄色葡萄球菌或任何金黄色葡萄球菌感染）后，女性治疗失败的可能性降低了 29%（优势比，0.71；95%CI，0.54 至 0.017；P = 0.017）。纳入的 64 项系统评价研究均未进行性别特异性分析。
结论
对于在手术后 1 年内发生 PJI 的患者，女性比男性更有可能成功接受 DAIR 治疗。其他因素对男性和女性的结果也有不同的影响。在骨科研究中实施性别特异性分析至关重要。
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