Kubsad Sanjay, Collins Andrew P, Dasari Suhas P, Chansky Howard A, Fernando Navin D, Hernandez Nicholas M
From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
J Am Acad Orthop Surg. 2025 Mar 15;33(6):307-312. doi: 10.5435/JAAOS-D-24-00290. Epub 2024 Sep 10.
Extended oral prophylactic antibiotics have been increasingly used in arthroplasty with the goal of reducing the risk of prosthetic joint infection (PJI). While a reduction in the rate of PJI has been noted with extended oral antibiotic regimens in high-risk patients, no large database study has assessed infection risk after primary total hip arthroplasty among well-balanced cohorts receiving and not receiving postoperative extended oral antibiotics.
A retrospective cohort study was conducted using a national database, TriNetX, to identify patients who underwent primary total hip arthroplasty. This cohort was stratified by oral antibiotic prescription within one day of procedure. A one-to-one propensity score matching based on age, sex, class of obesity, and medical comorbidities was conducted. Outcomes explored in this study were 90-day risk of PJI, superficial skin infection, deep skin infection, and all-cause revision.
90-day postoperative infection complications of PJI were higher in the group receiving antibiotics (hazard ratio: 1.83, P -value = 0.012). Other complications such as superficial skin infection, deep skin infection, and all-cause revision showed no statistically significant differences.
This database analysis of 5,476 patients demonstrated no decrease in complications of PJI, superficial or deep skin infection, or revision at 90 days. Future randomized controlled trials are needed to evaluate the efficacy of extended oral antibiotics.
III.
延长口服预防性抗生素在关节置换术中的使用日益增加，目的是降低人工关节感染（PJI）的风险。虽然在高危患者中，延长口服抗生素方案已使PJI发生率有所降低，但尚无大型数据库研究评估在接受和未接受术后延长口服抗生素的均衡队列中，初次全髋关节置换术后的感染风险。
使用国家数据库TriNetX进行一项回顾性队列研究，以确定接受初次全髋关节置换术的患者。该队列根据术后一天内的口服抗生素处方进行分层。基于年龄、性别、肥胖类别和合并症进行一对一倾向评分匹配。本研究探讨的结局包括PJI的90天风险、浅表皮肤感染、深部皮肤感染和全因翻修。
接受抗生素治疗的组中，PJI的术后90天感染并发症更高（风险比：1.83，P值=0.012）。其他并发症，如浅表皮肤感染、深部皮肤感染和全因翻修，在统计学上无显著差异。
对5476例患者的该数据库分析表明，90天时PJI、浅表或深部皮肤感染或翻修的并发症并未减少。未来需要进行随机对照试验来评估延长口服抗生素的疗效。
III级。
