Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Orthop Res. 2024 Oct;42(10):2345-2352. doi: 10.1002/jor.25903. Epub 2024 May 26.
To minimize periprosthetic joint infection (PJI) risk, some clinicians prescribe extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA). Given the limited evidence supporting EAP, we sought to evaluate impact of prophylactic antibiotic duration on PJI risk in a murine TJA model. A titanium prosthesis was implanted into the proximal tibia of 89 mice and inoculated with 10 colony forming units (cfu) of Staphylococcus aureus Xen36. Control mice (n = 20) did not receive antibiotics. Treated mice received either 24 h (n = 35) or 4 days (n = 34) of cefazolin prophylaxis. Cultures were obtained from the prostheses, tibia, femur, and knee tissues 3 weeks after surgery. All mice in the control group developed PJI. Both prophylaxis regimens reduced the rate of PJI relative to the control, with only 2/35 mice in the 24-h cohort (p < 0.0001) and 1/34 in 4-day cohort developing PJI (p < 0.0001). CFU counts from the prostheses, bone and knee tissues were reduced for the 24-h and 4-day prophylaxis cohorts relative to the control (p < 0.0001 for both). There was no difference in rates of PJI or CFU counts between the two prophylaxis cohorts (p = 0.58). Prophylactic cefazolin profoundly reduced rates of PJI in a murine model of TJA in which all control animals developed PJI. Extending cefazolin prophylaxis duration from 24 h to 4 days did not result in improved PJI rates or decreased bacterial loads in infected cases. While these results strongly support use of antibiotic prophylaxis for TJA, EAP did not appear to add benefit in the described mouse model.
为了最大限度地降低人工关节假体周围感染（PJI）的风险，一些临床医生在全膝关节置换术后（TJA）会开具延长抗生素预防用药（EAP）。鉴于支持 EAP 的证据有限，我们试图在 TJA 小鼠模型中评估预防性抗生素持续时间对 PJI 风险的影响。将钛假体植入 89 只小鼠的胫骨近端，并接种 10 个金黄色葡萄球菌 Xen36 的集落形成单位（cfu）。对照组（n=20）的小鼠未接受抗生素治疗。治疗组的小鼠分别接受 24 小时（n=35）或 4 天（n=34）头孢唑啉预防用药。术后 3 周从假体、胫骨、股骨和膝关节组织中获取培养物。对照组的所有小鼠均发生 PJI。两种预防方案均降低了 PJI 的发生率，与对照组相比，24 小时组只有 2/35 只小鼠（p<0.0001）和 4 天组 1/34 只小鼠（p<0.0001）发生 PJI。与对照组相比，24 小时和 4 天预防组的假体、骨和膝关节组织的 CFU 计数均降低（p<0.0001，两者均）。两种预防方案的 PJI 发生率或 CFU 计数均无差异（p=0.58）。头孢唑啉预防性治疗在 TJA 小鼠模型中显著降低了 PJI 的发生率，所有对照组动物均发生 PJI。将头孢唑啉预防用药持续时间从 24 小时延长至 4 天，并未改善 PJI 发生率或降低感染病例的细菌负荷。虽然这些结果强烈支持 TJA 使用抗生素预防用药，但在描述的小鼠模型中，EAP 似乎没有带来额外的益处。
