From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN (Mohiuddin), Department of Family Medicine, Ascension St. Vincent Hospital, Indianapolis, IN (Rice), Indiana University Health Multispecialty Musculoskeletal Center, Carmel, IN (Ziemba-Davis), Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN (Meneghini).
J Am Acad Orthop Surg. 2024 May 15;32(10):472-480. doi: 10.5435/JAAOS-D-23-00750. Epub 2024 Feb 13.
Few US studies have investigated the efficacy of extended oral antibiotic prophylaxis (EOAP) in the prevention of periprosthetic joint infection (PJI) after aseptic revision total hip arthroplasty (R-THA). This study compared PJI rates in aseptic R-THA performed with EOAP with PJI rates in published studies of aseptic R-THA patients not receiving EOAP.
Prospectively documented data on 127 consecutive aseptic R-THAs were retrospectively reviewed. Evidence-based perioperative infection prevention protocols were used, and all patients were discharged on 7-day EOAP. Superficial and deep infections at 30 and 90 days postoperatively and at mean latest follow-up of 27.8 months were statistically compared with all US studies reporting the prevalence of PJI after aseptic R-THA. Complications related to EOAP within 120 days of the index procedure also are reported.
No superficial or deep infections were observed at 30 and 90 days postoperatively when 7-day postdischarge EOAP was used. Superficial and deep infection rates were 1.57% (two patients) and 3.15% (four patients) at mean latest follow-up, respectively. Comparisons with published 30-day PJI rates of 1.37% ( P = 0.423) and 1.85% ( P = 0.257) were not statistically significant. Two of four comparisons with published 90-day PJI rates of 3.43% ( P = 0.027) and 5.74% ( P = 0.001) were statistically different. The deep PJI rate of 3.15% at mean latest follow-up was significantly lower than two of three published rates at equivalent follow-up including 10.10% ( P = 0.009) and 9.12% ( P = 0.041). No antibiotic-related complications were observed within 120 days of the index procedure.
Study findings possibly support the use of EOAP after aseptic R-THA to prevent catastrophic PJI with revision implants, indicating that the efficacy of EOAP cannot be definitively ruled-in or ruled-out based on available evidence.
在美国，很少有研究调查延长口服抗生素预防（EOAP）在预防无菌性翻修全髋关节置换术（R-THA）后假体周围关节感染（PJI）的疗效。本研究比较了接受 EOAP 的无菌性 R-THA 患者的 PJI 发生率与未接受 EOAP 的已发表无菌性 R-THA 患者研究的 PJI 发生率。
回顾性分析了 127 例连续无菌性 R-THA 的前瞻性记录数据。使用循证围手术期感染预防方案，所有患者出院后接受 7 天 EOAP。统计比较了术后 30 天和 90 天以及平均 27.8 个月的末次随访时的浅表和深部感染，并与所有报告无菌性 R-THA 后 PJI 发生率的美国研究进行比较。还报告了索引手术 120 天内与 EOAP 相关的并发症。
当使用 7 天出院后 EOAP 时，术后 30 天和 90 天未观察到浅表或深部感染。在平均末次随访时，浅表和深部感染率分别为 1.57%（2 例）和 3.15%（4 例）。与已发表的 30 天 PJI 率 1.37%（P=0.423）和 1.85%（P=0.257）相比，差异无统计学意义。与已发表的 90 天 PJI 率 3.43%（P=0.027）和 5.74%（P=0.001）的 4 次比较中有 2 次差异有统计学意义。平均末次随访时深部 PJI 率 3.15%明显低于包括 10.10%（P=0.009）和 9.12%（P=0.041）在内的 3 项已发表的深部 PJI 率。在索引手术 120 天内未观察到与抗生素相关的并发症。
研究结果可能支持在无菌性 R-THA 后使用 EOAP 来预防灾难性的翻修假体感染，这表明基于现有证据，EOAP 的疗效不能被明确确定或排除。
