دانلود مقاله تاثیر پروفیلاکسی آنتی بیوتیک غیر سفالوسپورینی بر عفونت مفصلی
خلاصه
معرفی
مواد و روش ها
نتایج
بحث
تضاد علاقه
بیانیه نویسنده CRediT
منابع
Summary
Introduction
Methods
Results
Discussion
Conflicts of interest
CRediT author statement
References
چکیده
سابقه و هدف: سفالوسپورین ها به عنوان پروفیلاکسی آنتی بیوتیکی خط اول در جراحی تعویض کامل مفصل توصیه می شوند. مطالعات نشان داده‌اند که در صورت استفاده از آنتی‌بیوتیک‌های غیرسفالوسپورینی، خطر عفونت مفصل پری پروتزی (PJI) افزایش می‌یابد. این مطالعه به بررسی اثر پروفیلاکسی آنتی بیوتیکی غیرسفالوسپورینی بر خطر ابتلا به PJI می پردازد.
روش‌ها: بیمارانی که از سال 2012 تا 2020 تعویض مفصل ران یا زانو انجام شده بودند، شناسایی شدند (27220 تعویض مفصل). پیامد اولیه، وقوع PJI در یک پیگیری یک ساله بود. ارتباط بین پروفیلاکسی آنتی بیوتیکی بعد از عمل و نتیجه با استفاده از تحلیل رگرسیون لجستیک مورد بررسی قرار گرفت.
بحث: سفوروکسیم به عنوان پروفیلاکسی در 26467 عمل (97.2%)، کلیندامایسین در 654 (2.4%) و وانکومایسین در 72 عمل (0.3%) مورد استفاده قرار گرفت. بروز PJI 0.86٪ (228/26467) با سفوروکسیم و 0.80٪ (6/753) با سایر آنتی بیوتیک های پروفیلاکتیک بود. هیچ تفاوتی در خطر ابتلا به PJI با آنتی‌بیوتیک‌های پیشگیرانه مختلف در تک متغیره (OR 1.06، 95% فاصله اطمینان (CI): 0.47e2.39) یا تجزیه و تحلیل چند متغیره (OR 1.02، 95% فاصله اطمینان (CI): 0.45e2.30) وجود نداشت.
نتیجه‌گیری: پروفیلاکسی آنتی‌بیوتیکی غیرسفالوسپورینی در جراحی تعویض کامل مفصل اولیه با افزایش خطر PJI مرتبط نبود.
Summary
Background
Cephalosporins are recommended as first-line antibiotic prophylaxis in total joint replacement surgery. Studies have shown an increased risk for periprosthetic joint infection (PJI) when non-cephalosporin antibiotics have been used. This study examines the effect of non-cephalosporin antibiotic prophylaxis on the risk for PJI.
Methods
Patients with a primary hip or knee replacement performed from 2012 to 2020 were identified (27 220 joint replacements). The primary outcome was the occurrence of a PJI in a one-year follow-up. The association between perioperative antibiotic prophylaxis and the outcome was examined using logistic regression analysis.
Discussion
Cefuroxime was used as prophylaxis in 26,467 operations (97.2%), clindamycin in 654 (2.4%) and vancomycin in 72 (0.3%). The incidence of PJI was 0.86% (228/26,467) with cefuroxime and 0.80% (6/753) with other prophylactic antibiotics. There was no difference in the risk for PJI with different prophylactic antibiotics in the univariate (OR 1.06, 95% CI 0.47–2.39) or multivariable analysis (OR 1.02, 95% CI 0.45–2.30).
Conclusion
Non-cephalosporin antibiotic prophylaxis in primary total joint replacement surgery was not associated with an increased risk for PJI.
Introduction
Periprosthetic joint infection (PJI) is one of the most feared complications after prosthetic joint surgery and therefore it is essential to prevent them. Perioperative antibiotic prophylaxis has a well-established role in the prevention of surgical site infections (SSIs) related to prosthetic joint surgery. First- or second-generation cephalosporins are recommended as first-line prophylactic antibiotics. [1].
The most common reasons to use non-cephalosporin prophylactic antibiotics are reported penicillin allergy and carriage of methicillin resistant Staphylococcus aureus (MRSA) [1]. The prevalence of a reported penicillin allergy among patients with prosthetic joint surgery has been between 2.5–17% [[2], [3], [4], [5]]. Cephalosporins are often avoided and other prophylactic antibiotics, such as clindamycin or vancomycin, are given prior to joint replacement surgery to patients with a reported penicillin allergy [2,4].
Studies have shown an association between a reported penicillin or beta-lactam allergy and an increased risk of SSI after joint replacement surgery [5], even though this association has not been evident in all studies [2]. The increased risk for SSI associated with reported penicillin allergy is postulated to be due to the use of non-cephalosporin prophylactic antibiotics [6]. The risk for infection after prosthetic joint surgery has been shown to be higher when clindamycin has been compared with cloxacillin [7] and when vancomycin has been compared with cefazolin [4,8]. Wyles et al. showed that the risk for infection after prosthetic joint surgery was significantly higher when non-cefazolin prophylactic antibiotics were used [3].
Results
The study population consisted of 27,220 primary joint replacement surgeries performed on 22,497 patients. Of these surgeries, 12,452 (46%) were hip replacements and 14 768 (54%) were knee replacements. In addition, 1450 (5%) of the joint replacement surgeries were bilateral.
vvCefuroxime was used as prophylaxis in 26,467 operations (97.2%), other antibiotics were used as follows: clindamycin 654 (2.4%), vancomycin 72 (0.3%) and other antibiotics in 27 (0.1%) operations. The proportion of women was higher, and patients were slightly younger, had a higher BMI and higher ASA scores among those receiving non-cefuroxime antibiotic prophylaxis than those receiving cefuroxime (Table I). Surgeries with non-cefuroxime antibiotic prophylaxis were longer in duration than those with cefuroxime prophylaxis (Table I).