围手术期给药抗生素能降低选择性手部软组织手术患者假关节感染的发生率吗？

IF 2.1 2区医学 Q2 ORTHOPEDICS

Journal of Hand Surgery-American Volume Pub Date : 2025-04-01 DOI:10.1016/j.jhsa.2025.01.002

Kelsey Young MD , Thompson Zhuang MD, MBA , Sophia Mavrommatis BS , Mitchell Hallman MD , Viviana Serra-Lopez MD , Ellis Berns MD , Andrew D. Sobel MD

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引用次数: 0

摘要

目的：尚未对已行全髋关节或膝关节置换术的患者在择期手部手术中预防性抗生素的使用进行研究。我们检验了零假设，即围手术期抗生素给药与选择性手部软组织手术患者假体关节感染（PJI）的发生率无关。方法：我们使用了一个大型的国家行政索赔数据库，以确定现有的全髋关节或膝关节置换术患者接受软组织手部手术（腕管松解术、de Quervain松解术、扳机指松解术、有限掌筋膜切除术、神经节或黏液囊肿切除术或软组织肿块切除术）。抗生素预防定义为当天静脉注射头孢唑林、万古霉素或克林霉素。接受抗生素治疗的患者与未接受抗生素治疗的患者按1:1的比例进行倾向评分匹配，考虑到年龄、性别、地理区域、保险计划、随后的手术以及是否存在合并症糖尿病、类风湿关节炎、心肌梗死、充血性心力衰竭、慢性肾脏疾病、人类免疫缺陷病毒感染、慢性肾脏疾病、恶性肿瘤、肥胖或吸烟。使用多变量逻辑回归调整匹配队列之间的残差。主要观察指标是手部手术后6、9和12个月内PJI的发生率。结果：手部手术后12个月内PJI总发生率为0.8%（166/21,582）。在手术后6个月（0.3% vs 0.5%）、9个月（0.6% vs 0.7%）或12个月（0.7% vs 0.8%），接受抗生素预防治疗的患者与未接受抗生素预防治疗的患者之间PJI发生率无差异。在校正了残留混杂因素后，这些发现没有变化。手部手术后3个月内的手术部位感染也与6、9或12个月的PJI无关。结论：我们发现术前全髋关节或膝关节置换术后进行手部软组织手术的患者预防性抗生素给药与术后6、9和12个月PJI的发生率无关联。研究类型/证据水平：预后II。

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Does Perioperative Antibiotic Administration Decrease the Incidence of Prosthetic Joint Infection in Patients Undergoing Elective Soft Tissue Hand Surgery?

Purpose

The use of prophylactic antibiotics in patients with existing total hip or knee arthroplasty undergoing elective hand surgery has not been studied. We tested the null hypothesis that perioperative antibiotic administration is not associated with the incidence of prosthetic joint infection (PJI) in patients undergoing elective, soft tissue hand surgery.

Methods

We used a large, national administrative claims database to identify patients with existing total hip or knee arthroplasty undergoing soft tissue hand surgery (carpal tunnel release, de Quervain release, trigger finger release, limited palmar fasciectomy, ganglion or mucoid cyst removal, or soft tissue mass removal). Antibiotic prophylaxis was defined as the same day administration of intravenous cefazolin, vancomycin, or clindamycin. Patients receiving antibiotics were propensity score-matched in a 1:1 ratio to those who did not, accounting for age, sex, geographic region, insurance plan, subsequent surgeries, and the presence of comorbid diabetes mellitus, rheumatoid arthritis, myocardial infarction, congestive heart failure, chronic kidney disease, human immunodeficiency virus infection, chronic kidney disease, malignancy, obesity, or tobacco use. Residual differences between matched cohorts were adjusted for using multivariable logistic regression. The primary outcome was the incidence of PJI within 6, 9, and 12 months after hand surgery.

Results

The overall incidence of PJI was 0.8% (166/21,582) within 12 months after hand surgery. There was no difference in the incidence of PJI between patients who received antibiotic prophylaxis and those who did not at 6 (0.3% vs 0.5%), 9 (0.6% vs 0.7%), or 12 months (0.7% vs 0.8%) after hand surgery. These findings were unchanged after adjusting for residual confounding. Surgical site infection within 3 months after hand surgery was also not associated with PJI at 6, 9, or 12 months.

Conclusions

We found no association between prophylactic antibiotic administration in patients with prior total hip or knee arthroplasty undergoing soft tissue hand surgery and the incidence of PJI at 6, 9, and 12 months after surgery.

Type of study/level of evidence

Prognostic II.

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来源期刊

Journal of Hand Surgery-American Volume 医学-外科

CiteScore

3.20

自引率

10.50%

发文量

402

审稿时长

12 weeks

期刊介绍： The Journal of Hand Surgery publishes original, peer-reviewed articles related to the pathophysiology, diagnosis, and treatment of diseases and conditions of the upper extremity; these include both clinical and basic science studies, along with case reports. Special features include Review Articles (including Current Concepts and The Hand Surgery Landscape), Reviews of Books and Media, and Letters to the Editor.