Antimicrobial prophylaxis with teicoplanin plus gentamicin in primary total joint arthroplasty

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2023-10-30 DOI:10.5194/jbji-8-219-2023
Tariq Azamgarhi, Craig Gerrand, John A. Skinner, Alexander Sell, Robert A. McCulloch, Simon Warren
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Abstract

Abstract. Objectives: To compare prosthetic joint infection (PJI) and acute kidney injury (AKI) rates among cohorts before and after changing our hospital's antimicrobial prophylactic regimen from cefuroxime to teicoplanin plus gentamicin. Methods: We retrospectively studied all patients undergoing primary total joint arthroplasty at our hospital 18 months pre- and post-implementation of the change in practice. All deep infections identified during follow-up were assessed against the European Bone and Joint Infection Society (EBJIS) definitions for PJI. Survival analysis using Cox regression was employed to adjust for differences in baseline characteristics and compare the risk of PJI between the groups. AKIs were identified using pathology records and categorized according to the KDIGO (Kidney Disease – Improving Global Outcomes) criteria. AKI rates were calculated for the pre- and post-intervention periods. Results: Of 1994 evaluable patients, 1114 (55.9 %) received cefuroxime only (pre-intervention group) and 880 (44.1 %) patients received teicoplanin plus gentamicin (post-intervention group). The overall rate of PJI in our study was 1.50 % (30 of 1994), with a lower PJI rate in the post-intervention group (0.57 %; 5 of 880) compared with the pre-intervention group (2.24 %; 25 of 1114). A corresponding risk reduction for PJI of 75.2 % (95 % CI of 35.2–90.5; p=0.004) was seen in the post-intervention group, which was most pronounced for early-onset and delayed infections due to coagulase-negative staphylococci (CoNS) and cefuroxime-resistant Enterobacteriaceae. Significantly higher AKI rates were seen in the post-intervention group; however, 84 % of cases (32 of 38) were stage 1, and there were no differences in the rate of stage-2 or -3 AKI. Conclusions: Teicoplanin plus gentamicin was associated with a significant reduction in PJI rates compared with cefuroxime. Increases in stage-1 AKI were seen with teicoplanin plus gentamicin.
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替柯planin联合庆大霉素在初次全关节置换术中的抗菌预防
摘要目的:比较我院抗菌预防方案由头孢呋辛改为替柯planin +庆大霉素前后各队列假体关节感染(PJI)和急性肾损伤(AKI)发生率。方法:我们回顾性研究了所有在我院接受首次全关节置换术前后18个月的患者。随访期间发现的所有深部感染均根据欧洲骨和关节感染协会(EBJIS)对PJI的定义进行评估。采用Cox回归的生存分析来调整基线特征的差异,并比较两组之间PJI的风险。根据病理记录确定AKIs,并根据KDIGO(肾脏疾病-改善全球预后)标准进行分类。计算干预前后的AKI发生率。结果:1994例可评估患者中,干预前组仅使用头孢呋辛1114例(55.9%),干预后组使用替柯planin +庆大霉素880例(44.1%)。本研究中PJI总发生率为1.50%(1994年30例),干预后组PJI发生率较低(0.57%;880例中有5例),与干预前组相比(2.24%;25 1114)。PJI的相应风险降低了75.2% (95% CI为35.2-90.5;p=0.004),最明显的是由凝固酶阴性葡萄球菌(con)和头孢呋辛耐药肠杆菌科引起的早发性和延迟性感染。干预后组AKI发生率显著升高;然而,84%的病例(38例中的32例)为1期,2期或3期AKI的发生率没有差异。结论:与头孢呋辛相比,替柯planin加庆大霉素可显著降低PJI发生率。替柯planin加庆大霉素组1期AKI发生率增高。
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CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
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