Lovallo Jeffrey L, Murray Ryan S, Wiesel Brent B, Curley Andrew J, Conroy Christine M, Johnson Douglass C
Orthopedics. 2023 Sep-Oct;46(5):310-314. doi: 10.3928/01477447-20230224-06. Epub 2023 Mar 1.
Deep infection is a debilitating complication after shoulder arthroplasty. The authors hypothesized that an intra-articular, intraoperative injection of antibiotics would result in a lower infection rate compared with intravenous antibiotics alone. Before 2007, 164 patients (group A) did not receive intra-articular antibiotics. From 2007 to 2018, 1324 patients (group B) received intra-articular antibiotics. Patients received intra-articular gentamicin at the end of surgery with the addition of 1 g of cefazolin in January 2014. Records were retrospectively reviewed for comorbidities, type of surgery, and infection. The cohort that received intra-articular antibiotics was compared with the cohort that did not to determine the effect of prophylactic intra-articular antibiotic administration in preventing infection. There was 1 deep infection in the antibiotic group compared with 5 in the non-antibiotic group (<.001). Superficial infections developed in 2 cases of patients treated with antibiotics; there were no superficial infections in patients treated without antibiotics (=.62). One previous study evaluated intra-articular injection of antibiotics for shoulder arthroplasty and found significantly lower rates of infection with the injection of intra-articular gentamicin. In this retrospective follow-up study, the injection of intra-articular gentamicin or gentamicin and cefazolin effectively decreased rates of postoperative infection. At mean follow-up of 399 days, intra-articular antibiotics at the time of surgery resulted in significantly fewer deep infections. Given the minimal risk of adverse events and minimal cost, this is a valid method of reducing infections in total shoulder arthroplasty. [. 2023;46(5):310-314.].
深部感染是肩关节置换术后一种使人虚弱的并发症。作者推测，与单纯静脉使用抗生素相比，术中关节腔内注射抗生素会使感染率更低。2007年之前，164例患者（A组）未接受关节腔内抗生素治疗。2007年至2018年，1324例患者（B组）接受了关节腔内抗生素治疗。2014年1月，患者在手术结束时接受关节腔内庆大霉素注射，并加用1克头孢唑林。对患者的合并症、手术类型和感染情况进行了回顾性记录审查。将接受关节腔内抗生素治疗的队列与未接受该治疗的队列进行比较，以确定预防性关节腔内抗生素给药对预防感染的效果。抗生素组有1例深部感染，而非抗生素组有5例（P<0.001）。接受抗生素治疗的患者中有2例发生了浅表感染；未接受抗生素治疗的患者中没有浅表感染（P = 0.62）。此前有一项研究评估了肩关节置换术中关节腔内注射抗生素的情况，发现注射关节腔内庆大霉素后感染率显著降低。在这项回顾性随访研究中，关节腔内注射庆大霉素或庆大霉素与头孢唑林有效降低了术后感染率。在平均399天的随访中，手术时关节腔内使用抗生素导致深部感染显著减少。鉴于不良事件风险极小且成本最低，这是一种降低全肩关节置换术感染率的有效方法。[《. 2023;46(5):310 - 314.》]
