Motta Leonardo, Stroffolini Giacomo, Marocco Stefania, Bertoli Giulia, Piovan Gianluca, Povegliano Lorenzo, Zorzi Claudio, Gobbi Federico
Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy.
Department of Orthopaedic and Traumatology, S. Cuore-Don Calabria Hospital, Negrar, 37024 Verona, Italy.
Antibiotics (Basel). 2025 Feb 21;14(3):224. doi: 10.3390/antibiotics14030224.
The prosthetic knee infection (PKI) rate in most centers ranges from 0.5 to 2% for knee replacements, depending on risk factors. Current PKI definitions may miss the identification of both early and late complications. There is no consensus on preventive or early empiric antibiotic therapy (EEAT) in the one-step exchange strategy for low-risk patients pending microbiology results. The aim of the study was to evaluate the potential role of EEAT in patients with comorbidities in preventing PKI and to evaluate differences in septic failure at 3, 6 and 9 months after prosthetic revision between patients undergoing EEAT and patients not undergoing EEAT. All adult patients undergoing one-step knee revision surgery at IRCCS Sacro-Cuore Don Calabria Negrar, from January 2018 to February 2021, were retrospectively included in a cohort observational study. Patients on antibiotic therapy before surgery or with preoperative ascertained PKI were excluded. Demographic characteristics, Charlson score, comorbidities, inflammatory markers, microbiological tests, imaging, infectious disease risk score and EEAT data were collected. Any postoperative complication or modification of antibiotic therapy at 14, 30, 90, 180 and 270 days after surgery was collected. A total of 227 patients were included: 114 comorbid low-risk patients received EEAT after surgery, pending microbiological results; while 113 non-comorbid low-risk patients did not receive any antibiotic therapy in the postoperative period. Among the EEAT group, 16 were diagnosed with PKI, compared with 10 in the untreated group. Regarding septic failure during the 9-month follow-up after revision surgery, we registered nine cases in the EEAT arm and four in the untreated arm. In three out of nine cases treated with EEAT who had a post-revision septic failure, the causative microorganism was not successfully empirically targeted by EEAT; in the untreated group, two out of four cases had a post-revision septic failure, despite the targeted treatment of intraoperatively identified causative microorganisms. According to our results, EEAT after revision surgery in patients with comorbidities, who are at higher risk of infection, did not prevent prosthetic knee infections. There was also no evidence of a reduction in subsequent septic failure within nine months of revision surgery between groups. More accurate risk-defining scores are needed to identify patients at risk of PKI complications.
对于膝关节置换手术，大多数中心的人工膝关节感染（PKI）率在0.5%至2%之间，具体取决于风险因素。当前的PKI定义可能无法识别早期和晚期并发症。对于低风险患者在等待微生物学结果的一步式置换策略中，预防性或早期经验性抗生素治疗（EEAT）尚无共识。本研究的目的是评估EEAT在合并症患者预防PKI中的潜在作用，并评估接受EEAT和未接受EEAT的患者在假体翻修后3个月、6个月和9个月时败血症性衰竭的差异。2018年1月至2021年2月在IRCCS Sacro-Cuore Don Calabria Negrar接受一步式膝关节翻修手术的所有成年患者被回顾性纳入一项队列观察研究。排除术前接受抗生素治疗或术前已确诊PKI的患者。收集人口统计学特征、Charlson评分、合并症、炎症标志物、微生物学检查、影像学检查、传染病风险评分和EEAT数据。收集术后14天、30天、90天、180天和270天的任何术后并发症或抗生素治疗的调整情况。共纳入227例患者：114例合并症低风险患者术后在等待微生物学结果时接受了EEAT；而113例无合并症低风险患者在术后未接受任何抗生素治疗。在EEAT组中，16例被诊断为PKI，未治疗组为10例。关于翻修手术后9个月随访期间的败血症性衰竭，我们在EEAT组记录了9例，未治疗组记录了4例。在接受EEAT治疗且翻修后出现败血症性衰竭的9例患者中，有3例的致病微生物未被EEAT成功经验性靶向；在未治疗组中，4例中有2例翻修后出现败血症性衰竭，尽管对术中确定的致病微生物进行了靶向治疗。根据我们的结果，合并症患者术后感染风险较高，接受EEAT并不能预防人工膝关节感染。也没有证据表明两组在翻修手术后9个月内后续败血症性衰竭有所减少。需要更准确的风险定义评分来识别有PKI并发症风险的患者。
