Pisharody Vivek A, Fuqua Andrew, Ayeni Ayomide, Erens Greg A, Wilson Jacob M, Premkumar Ajay
Emory University School of Medicine, Atlanta, Georgia.
Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.
J Arthroplasty. 2025 May;40(5):1117-1122. doi: 10.1016/j.arth.2024.11.017. Epub 2024 Nov 15.
Recent evidence suggests extended courses of oral antibiotics (EOA) after total hip arthroplasty and total knee arthroplasty (TKA) may reduce the risk of periprosthetic joint infection in high-risk patients. EOA rates after total hip arthroplasty have risen significantly. However, there is a lack of epidemiologic data on EOA prophylaxis following TKA. Therefore, we investigated national trends in EOA prophylaxis for primary TKA and whether these rates were reflective of changes in patient risk or prescribing practices.
Adult patients undergoing TKA between 2009 and 2022 were identified in a national insurance claims database. An EOA was defined as a 7 to 14-day course of a first-generation cephalosporin, cefdinir, clindamycin, doxycycline, or trimethoprim-sulfamethoxazole filled between 5 days preoperatively and 3 days postoperatively. Annual EOA rates were calculated and stratified by preoperative periprosthetic joint infection risk. Multivariable logistic regression was used to explore whether rates reflected changing patient characteristics. Future rates were predicted with time-series forecasting.
We identified 712,212 eligible TKA cases. EOA rates rose from 0.91% in 2009 to 7.95% in 2022. Rates increased by 686% among standard-risk patients and 786% among high-risk patients. Logistic regression models using patient comorbidities could not account for changes in EOA rates. EOA rates were projected to rise to 18.3% by 2030.
Rates of EOA prophylaxis after TKA rose significantly from 2009 to 2022. This trend could not be explained by changing patient characteristics, suggesting widespread changes in antibiotic prescribing practices, which may be reflective of recent studies favoring EOA use. There is a need for further high-quality research examining the safety, efficacy, and role of EOA prophylaxis in the primary TKA patient population.
近期证据表明，全髋关节置换术和全膝关节置换术（TKA）后延长口服抗生素疗程（EOA）可能会降低高危患者假体周围关节感染的风险。全髋关节置换术后的EOA使用率显著上升。然而，目前缺乏关于TKA术后EOA预防的流行病学数据。因此，我们调查了初次TKA的EOA预防的全国趋势，以及这些比率是否反映了患者风险或处方习惯的变化。
在一个全国性保险理赔数据库中识别出2009年至2022年间接受TKA的成年患者。EOA被定义为术前5天至术后3天内开具的为期7至14天的第一代头孢菌素、头孢地尼、克林霉素、多西环素或甲氧苄啶-磺胺甲恶唑疗程。计算年度EOA使用率，并按术前假体周围关节感染风险进行分层。使用多变量逻辑回归来探讨这些比率是否反映了患者特征的变化。通过时间序列预测来预测未来的比率。
我们识别出712,212例符合条件的TKA病例。EOA使用率从2009年的0.91%上升至2022年的7.95%。标准风险患者的比率增加了686%，高危患者的比率增加了786%。使用患者合并症的逻辑回归模型无法解释EOA使用率的变化。预计到2030年，EOA使用率将升至18.3%。
2009年至2022年，TKA术后EOA预防的比率显著上升。这一趋势无法通过患者特征的变化来解释，表明抗生素处方习惯发生了广泛变化，这可能反映了近期支持使用EOA的研究。需要进一步开展高质量研究，以检验EOA预防在初次TKA患者群体中的安全性、有效性和作用。
