Freshman Ryan D, Fathi Amir, Orringer Matthew, Kotlier Jacob L, Mayfield Cory K, Lin Eric H, Feingold Cailan L, Petrigliano Frank A, Liu Joseph N
Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
JSES Int. 2025 Apr 30;9(4):1286-1292. doi: 10.1016/j.jseint.2025.04.001. eCollection 2025 Jul.
This study aimed to evaluate different prophylactic antibiotic regimens and risk for acute postoperative readmissions, infections, and medical complications.
This retrospective cohort study used the Premier Healthcare Database to identify patients who underwent primary elective shoulder arthroplasty procedures over the age of 18. The database was queried to identify perioperative antibiotic regimens using specific codes for cefazolin, clindamycin, and vancomycin. Patients receiving cefazolin monotherapy for prophylactic antibiotic regimen were used as a control group and multivariate logistic regression was then used to calculate odd ratios for postoperative complications within 90 days of the procedure.
A total of 139,032 patients undergoing primary shoulder arthroplasty between 2016 and 2020 were included. Cefazolin monotherapy was the most prescribed antibiotic regimen (59.3%), followed by vancomycin and cefazolin combination therapy (23.3%), vancomycin monotherapy (8.6%), clindamycin monotherapy (5.6%), and vancomycin and clindamycin combination therapy (3.2%). Monotherapy with clindamycin or vancomycin was associated with increased risk of periprosthetic joint infection ( < .001). Vancomycin use as monotherapy or combination with another antibiotic increased the risk of postoperative acute kidney injury ( = .017-.001).
Compared to vancomycin and clindamycin monotherapy, cefazolin monotherapy was associated with a lower risk of developing acute postoperative periprosthetic joint infection. The results of this study support the use of cefazolin monotherapy as the current standard for patients undergoing primary total shoulder arthroplasty.
本研究旨在评估不同的预防性抗生素方案以及急性术后再入院、感染和医疗并发症的风险。
这项回顾性队列研究使用Premier医疗数据库来识别18岁以上接受初次择期肩关节置换手术的患者。通过查询数据库，使用头孢唑林、克林霉素和万古霉素的特定编码来识别围手术期抗生素方案。接受头孢唑林单药预防性抗生素方案的患者作为对照组，然后使用多因素逻辑回归计算手术后90天内术后并发症的比值比。
共纳入了2016年至2020年间139,032例接受初次肩关节置换术的患者。头孢唑林单药治疗是最常用的抗生素方案（59.3%），其次是万古霉素和头孢唑林联合治疗（23.3%）、万古霉素单药治疗（8.6%）、克林霉素单药治疗（5.6%）以及万古霉素和克林霉素联合治疗（3.2%）。克林霉素或万古霉素单药治疗与假体周围关节感染风险增加相关（<.001）。使用万古霉素单药治疗或与另一种抗生素联合使用会增加术后急性肾损伤的风险（=.017-.001）。
与万古霉素和克林霉素单药治疗相比，头孢唑林单药治疗与术后急性假体周围关节感染的风险较低相关。本研究结果支持使用头孢唑林单药治疗作为初次全肩关节置换术患者的当前标准。
