Mabrouk Ahmed, Abouharb Alexander, Stewart Gabriel, Palan Jeya, Pandit Hemant
Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
Bone Jt Open. 2023 Oct 6;4(10):742-749. doi: 10.1302/2633-1462.410.BJO-2023-0055.R1.
Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance.
The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital's website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance.
The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance.
This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended.
在英国，各医院和医疗信托机构用于择期初次全髋关节和膝关节置换术的预防性抗生素方案差异很大。本研究旨在确定目前英国各地用于择期初次关节置换术的抗生素预防方案，确定抗生素预防方案的差异及其对初次手术后第一年假体周围关节感染（PJI）风险的影响，并评估对当前国际共识指南的遵循情况。
通过搜索英国109家医院和医疗信托机构各自的网站（内部网页）以及使用MicroGuide应用程序，获取英国109家医院和医疗信托机构在清洁骨科手术（初次关节置换术）中主要和替代推荐的预防性抗生素方案的指南。使用英国国家处方集（BNF）的价格数据计算每种抗生素方案的平均成本。然后将这些方案与2018年费城共识指南进行比较，以评估对国际指南的遵循情况。
预防性抗菌方案的主要选择和剂量差异很大。使用最多的两种方案是替考拉宁和庆大霉素联合使用，以及头孢呋辛，然后每8小时给予两或三剂头孢呋辛，各有24个中心（22.02%）推荐。在有数据的83个中心中，预防性抗菌方案的替代选择和剂量也有很大差异。一些中心的预防方案未能涵盖手术部位感染（SSI）最可能的病因。5个中心（4.59%）推荐使用阿莫西林克拉维酸，其没有覆盖作用，而33个中心（30.28%）推荐头孢呋辛，其也没有覆盖作用。观察到对2018年费城共识指南的遵循有限，67个中心（61.50%）在其指南中未包括头孢菌素。
对英国109家医院和医疗信托机构初次关节置换术抗菌预防指南的分析表明，目前推荐的主要和替代抗菌方案存在广泛差异。
