Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain.
Eur J Clin Microbiol Infect Dis. 2024 Jul;43(7):1319-1328. doi: 10.1007/s10096-024-04838-3. Epub 2024 May 15.
After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI.
Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors.
We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65).
The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.
由于人工关节感染（PJI）进行了两期关节置换后，新假体有很高的再感染（RePJI）风险。目前对于二期手术中抗生素预防用药并没有确凿的证据。本研究的目的是描述二期手术中使用的抗生素预防用药，并评估其对再感染风险的影响。
这是一项在西班牙医院进行的回顾性多中心病例对照研究。该研究纳入了因 PJI 接受两期关节置换且随后发生新感染的病例。每例病例纳入 2 名对照，按照假体位置、中心和手术年份进行匹配。根据抗生素的抗菌谱对预防方案进行分组，并用条件逻辑回归计算方案类型与 RePJI 发展之间的关联，同时校正可能的混杂因素。
共纳入了来自 12 家中心的 90 例病例，与 172 例对照进行比较。最常见的病原体是表皮葡萄球菌，共 34 例（37.8%）。葡萄球菌导致了 50 例（55.6%）感染，其中 32 例（64%）为耐甲氧西林金黄色葡萄球菌。革兰氏阴性杆菌导致了 30 例（33.3%）感染，最常见的病原体是铜绿假单胞菌。二期手术中共使用了 83 种不同的抗生素预防方案，最常见的是术前单次头孢唑啉（48 例；18.3%）；但最常见的方案是同时使用针对耐甲氧西林金黄色葡萄球菌和铜绿假单胞菌的糖肽类药物和β-内酰胺类药物（99 例，25.2%）。在调整分析中，包括针对耐甲氧西林金黄色葡萄球菌和铜绿假单胞菌的抗生素的方案与 RePJI 的风险显著降低相关（调整比值比=0.24；95%可信区间：0.09-0.65）。
二期手术预防用药缺乏标准化，这解释了该手术中预防用药方案存在很大差异。结果表明，该手术的抗生素预防用药应包括针对耐甲氧西林金黄色葡萄球菌和铜绿假单胞菌的抗生素。
