Rumalla Kranti C, Sontag-Milobsky Isaac L, Chen Austin R, Selph T Jacob, Compton Tyler M, Edelstein Adam I
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois.
J Arthroplasty. 2025 Jun 21. doi: 10.1016/j.arth.2025.06.057.
Conflicting reports exist on the relationship between antibiotic choice and periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We used a national database to investigate whether cefazolin usage reduced PJI risk compared with alternatives.
We queried a national database from 2016 to 2022 to identify primary TKAs using Current Procedural Terminology code 27447 and International Classification of Diseases Procedure Coding System codes (0SRD0xx, 0SRC0xx) linked to osteoarthritis (International Classification of Diseases Clinical Modification M17). This study included 528,250 primary TKA patients. A total of 53,776 (10.2%) received noncefazolin alone, 343,279 (65.0%) received cefazolin only, and 131,195 (24.8%) received cefazolin plus another antibiotic. Demographics, clinical characteristics, and outcomes were extracted. The PJIs were defined according to Centers for Medicare and Medicaid Services complication measure codes within 90 days. We compared three prophylaxis groups: cefazolin only, noncefazolin, or cefazolin plus another antibiotic. Multinomial logistic regression assessed the association between antibiotic use and PJI.
Univariate analysis showed 90-day PJI rates of 1.0% in noncefazolin versus 0.7% in both cefazolin-only and combination groups (P < 0.001). After adjusting for age, sex, payer, race, ethnicity, and comorbidities, both cefazolin-only (odds ratio 0.68, 95% confidence interval 0.62 to 0.75, P < 0.001) and cefazolin plus another antibiotic (odds ratio 0.74, 95% confidence interval 0.66 to 0.82, P < 0.001) were associated with reduced odds of PJI.
In conclusion, our nationally representative findings confirm that cefazolin prophylaxis significantly lowers 90-day PJI risk after TKA compared to alternative antibiotics. Surgeons should carefully consider patient allergies before deviating from cefazolin-based prophylaxis. Future research should clarify optimal strategies for patients reporting cefazolin allergies and those at higher infection risk, particularly immunocompromized patients.
关于全膝关节置换术（TKA）后抗生素选择与假体周围关节感染（PJI）之间的关系，存在相互矛盾的报道。我们使用一个全国性数据库来研究与其他抗生素相比，使用头孢唑林是否能降低PJI风险。
我们查询了2016年至2022年的一个全国性数据库，以识别使用当前手术操作术语代码27447以及与骨关节炎（国际疾病分类临床修订版M17）相关的国际疾病分类手术编码系统代码（0SRD0xx、0SRC0xx）的初次TKA病例。本研究纳入了528,250例初次TKA患者。共有53,776例（10.2%）仅接受非头孢唑林治疗，343,279例（65.0%）仅接受头孢唑林治疗，131,195例（24.8%）接受头孢唑林加另一种抗生素治疗。提取了人口统计学、临床特征和结局数据。PJI根据医疗保险和医疗补助服务中心90天内的并发症测量代码进行定义。我们比较了三个预防组：仅头孢唑林组、非头孢唑林组或头孢唑林加另一种抗生素组。多项逻辑回归分析评估了抗生素使用与PJI之间的关联。
单因素分析显示，非头孢唑林组90天PJI发生率为1.0%，而仅头孢唑林组和联合用药组均为0.7%（P<0.001）。在调整年龄、性别、付款人、种族、民族和合并症后，仅头孢唑林组（优势比0.68，95%置信区间0.62至0.75，P<0.001）和头孢唑林加另一种抗生素组（优势比0.74，95%置信区间0.66至0.82，P<0.001）与PJI发生几率降低相关。
总之，我们具有全国代表性的研究结果证实，与其他抗生素相比，头孢唑林预防可显著降低TKA后90天的PJI风险。在偏离基于头孢唑林的预防方案之前，外科医生应仔细考虑患者的过敏情况。未来的研究应阐明针对报告头孢唑林过敏的患者以及感染风险较高的患者，特别是免疫功能低下患者的最佳策略。
