Carter Brian J, Rumalla Kranti C, Sontag-Milobsky Isaac L, Chen Austin R, Suleiman Linda I, Edelstein Adam I
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois.
J Arthroplasty. 2025 Oct;40(10):2671-2678. doi: 10.1016/j.arth.2025.04.079. Epub 2025 May 6.
There have been conflicting reports on the risk of periprosthetic joint infection (PJI) with the use of alternative antibiotics to cefazolin following arthroplasty. We leveraged recent data from a nationally representative multipayer dataset to investigate this question.
We queried a health care dataset from 2016 to 2022 to identify primary total hip arthroplasties (THAs) using Current Procedural Terminology and International Classification of Disease (ICD)-Procedure Coding System codes (27130, 0SR90xx, 0SRB0xx) with a corresponding osteoarthritis diagnosis (ICD-Clinical Modification: M16). Patient demographics, characteristics, and outcomes were extracted from existing dataset variables. The PJIs were defined using ICD-10 diagnosis codes from the Centers for Medicare and Medicaid Services' procedure-specific complication measure within 90 days of surgery. We compared PJI between patients receiving cefazolin antibiotic prophylaxis and patients who received an alternative antibiotic or cefazolin plus another antibiotic. The association between cefazolin use and PJI was evaluated using multinomial logistic regression. This study included 289,369 primary THA patients from 2016 to 2022. There were 25,164 patients (8.7%) who received a non-cefazolin antibiotic, 200,367 (69.2%) received cefazolin only, and 63,838 (22.1%) received cefazolin plus an alternative antibiotic.
In univariate analysis, there was a significant difference in the rate of 90-day PJI between the non-cefazolin group, cefazolin only, and cefazolin plus other antibiotic group (0.9, 0.5, and 0.5%, respectively, P < 0.001). In a logistic regression analysis that adjusted for age, sex, payer, race, ethnicity, and Elixhauser Comorbidity Index, the use of cefazolin only and cefazolin plus other antibiotic were associated with reduced risk of 90-day PJI (odds ratio 0.62, 95% confidence interval [0.53 to 0.72], P < 0.001) and (odds ratio 0.64, 95% confidence interval [0.54 to 0.76], P < 0.001).
In this nationally representative multipayer study using recent data, patients who received antibiotic prophylaxis with cefazolin had lower 90-day rates of PJI compared to those receiving alternative antibiotics during primary THA.
关于关节置换术后使用头孢唑林以外的其他抗生素发生假体周围关节感染（PJI）的风险，一直存在相互矛盾的报道。我们利用来自全国代表性多支付方数据集的最新数据来研究这个问题。
我们查询了2016年至2022年的医疗保健数据集，使用当前操作术语和国际疾病分类（ICD）-手术编码系统代码（27130、0SR90xx、0SRB0xx）来识别初次全髋关节置换术（THA），并伴有相应的骨关节炎诊断（ICD-临床修正版：M16）。从现有数据集变量中提取患者的人口统计学信息、特征和结局。PJI使用医疗保险和医疗补助服务中心手术特定并发症指标中的ICD-10诊断代码在手术后90天内进行定义。我们比较了接受头孢唑林抗生素预防的患者与接受其他抗生素或头孢唑林加另一种抗生素的患者之间的PJI情况。使用多项逻辑回归评估头孢唑林的使用与PJI之间的关联。本研究纳入了2016年至2022年的289,369例初次THA患者。有25,164例患者（8.7%）接受了非头孢唑林抗生素，200,367例（69.2%）仅接受了头孢唑林，63,838例（22.1%）接受了头孢唑林加另一种抗生素。
在单因素分析中，非头孢唑林组、仅头孢唑林组和头孢唑林加其他抗生素组的90天PJI发生率存在显著差异（分别为0.9%、0.5%和0.5%，P<0.001）。在一项对年龄、性别、支付方、种族、民族和埃利克斯豪泽合并症指数进行调整的逻辑回归分析中，仅使用头孢唑林和头孢唑林加其他抗生素与90天PJI风险降低相关（比值比0.62，95%置信区间[0.53至0.72]，P<0.001）以及（比值比0.64，95%置信区间[0.54至0.76]，P<0.001）。
在这项使用最新数据的全国代表性多支付方研究中，与初次THA期间接受其他抗生素的患者相比，接受头孢唑林抗生素预防的患者90天PJI发生率更低。
