Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
J Arthroplasty. 2024 Sep;39(9S2):S122-S128. doi: 10.1016/j.arth.2024.04.064. Epub 2024 Apr 27.
Periprosthetic joint infection (PJI) is a devastating complication following both total hip (THA) and knee (TKA) arthroplasty. Extended oral antibiotic (EOA) prophylaxis has been reported to reduce PJI following TJA in high-risk patients. The purpose of this study was to determine if EOA reduces PJI in all-comers and high-risk THA and TKA populations.
This is a retrospective cohort study, including 4,576 patients undergoing primary THA or TKA at a single institution from 2018 to 2022. Beginning in 2020, EOA prophylaxis was administered for 10 days following THA or TKA at our institution. Patients were separated into 2 cohorts (1,769 EOA, 2,807 no EOA) based on whether they received postoperative EOA. The 90-day and 1-year outcomes, with a focus on PJI, were then compared between groups. A subgroup analysis of high-risk patients was also performed.
There was no difference in 90-day PJI rates between cohorts (EOA 1 versus no EOA 0.8%; P = .6). The difference in the rate of PJI remained insignificant at 1 year (EOA 1 versus no EOA 1%; P = .9). Similarly, our subgroup analysis of high-risk patients demonstrated no difference in postoperative PJI between EOA (n = 254) and no EOA (n = 396) (0.8 versus 2.3%, respectively; P = .2). Reassuringly, we also found no differences in the incidence of Clostridium difficile infection (EOA 0.1 versus no EOA 0.1%; P > .9) or in antibiotic resistance among those who developed PJI within 90 days (EOA 59 versus no EOA 83%; P = .2).
With the numbers available for analysis, EOA prophylaxis was not associated with PJI risk reduction following primary TJA when universally deployed. Furthermore, among high-risk patients, there was no statistically significant difference. While we did not identify increased antibiotic resistance or Clostridium difficile infection, we cannot recommend wide-spread adoption of EOA prophylaxis, and clarification regarding the role of EOA, even in high-risk patients, is needed.
假体周围关节感染（PJI）是全髋关节置换术（THA）和全膝关节置换术（TKA）后一种破坏性的并发症。有报道称，在高风险患者中，延长口服抗生素（EOA）预防可降低 TJA 后的 PJI 发生率。本研究的目的是确定 EOA 是否会降低所有患者和高风险 THA 和 TKA 人群的 PJI 发生率。
这是一项回顾性队列研究，纳入了 2018 年至 2022 年在一家单中心接受初次 THA 或 TKA 的 4576 例患者。自 2020 年起，我们中心对接受 THA 或 TKA 的患者术后使用 EOA 预防 10 天。根据患者是否接受术后 EOA，将其分为 2 组（1769 例 EOA，2807 例无 EOA）。然后比较两组患者的 90 天和 1 年结局，重点关注 PJI。还对高风险患者进行了亚组分析。
两组患者的 90 天 PJI 发生率无差异（EOA 组 1 例，无 EOA 组 0.8%；P=0.6）。1 年时 PJI 发生率无显著差异（EOA 组 1 例，无 EOA 组 1%；P=0.9）。同样，我们对高风险患者的亚组分析也显示，EOA 组（n=254）和无 EOA 组（n=396）的术后 PJI 发生率无差异（分别为 0.8%和 2.3%；P=0.2）。令人安心的是，我们还发现 90 天内发生 PJI 的患者中，艰难梭菌感染的发生率在 EOA 组（0.1%）和无 EOA 组（0.1%）之间无差异（P＞0.9），以及在发生 PJI 的患者中，抗生素耐药率也无差异（EOA 组 59 例，无 EOA 组 83 例；P=0.2）。
根据可分析的病例数，当普遍应用 EOA 预防时，它与初次 TJA 后 PJI 风险降低无关。此外，在高风险患者中，也没有统计学上的显著差异。虽然我们没有发现抗生素耐药性或艰难梭菌感染增加，但我们不能推荐广泛采用 EOA 预防，并且需要明确 EOA 的作用，即使在高风险患者中也是如此。
