一项回顾性研究表明，以硫酸钙作为载体材料进行局部抗生素治疗可改善髋关节置换术后假体周围关节感染的清创、抗生素和植入物保留手术的结果。

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2022-01-20 eCollection Date: 2022-01-01 DOI:10.5194/jbji-7-11-2022

Katharina Reinisch, Michel Schläppi, Christoph Meier, Peter Wahl

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The endpoints were treatment failure, defined as the need for a reoperation, either a second DAIR or a prosthesis removal or exchange due to persistent or recurrent infection, the initiation of a long-term suppressive antibiotic treatment, or death related to infection. Results: Considering any reoperation as an outcome, 11 of 14 cases treated without AB-CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> (79 %) and 4 of the 27 cases treated with AB-CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> failed (15 %). Considering revision as an outcome, 9 out of 14 cases treated without AB-CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> (64 %) and 4 of the 27 cases treated with AB-CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> (15 %) failed. A Kaplan-Meier survival analysis showed that local antibiotic delivery with CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> as the carrier material led to a significantly longer infection-free survival, considering any surgical revision ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0001</mn></mrow> </math> ; hazard ratio 8.9 (95 % CI 2.8-28.2)) or revision with component exchange ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.0015</mn></mrow> </math> ; hazard ratio 5.6 (95 % CI 1.7-18.2)) as the endpoint. 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引用次数: 6

摘要

目的:清创，抗生素和种植体保留(DAIR)是假体周围关节感染(PJIs)的既定治疗方式，但成功率各不相同。本研究比较了全髋关节置换术(THA)后，以caso4为载体材料，局部给药或不给药，DAIR治疗PJIs的成功率。方法:回顾性分析2010年至2018年间41例THA术后PJIs患者的DAIR治疗情况。27例患者采用以caso4为载体材料的局部抗生素DAIR治疗，14例患者采用标准DAIR治疗。终点是治疗失败，定义为由于持续或复发感染而需要再次手术，第二次DAIR或假体移除或置换，开始长期抑制抗生素治疗，或与感染相关的死亡。结果:考虑到再次手术的结局，14例未使用AB-CaSO - 4治疗的患者中有11例(79. %)，27例使用AB-CaSO - 4治疗的患者中有4例(15. %)失败。考虑到翻修作为结果，14例未使用AB-CaSO - 4治疗的患者中有9例(64% %)和27例使用AB-CaSO - 4治疗的患者中有4例(15% %)失败。Kaplan-Meier生存分析显示，考虑到任何手术翻修，以CaSO - 4为载体材料的局部抗生素递送可显著延长无感染生存期(p 0.0001;风险比8.9(95 % CI 2.8-28.2))或成分交换修正(p = 0.0015;风险比5.6(95 % CI 1.7-18.2))作为终点。结论:在全髋关节置换术后PJIs DAIR中加入以caso4为载体材料的局部抗生素，可显著提高无感染生存、任何再手术、特别是部件交换翻修的成功率。

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Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty - a retrospective study.

Purpose: Debridement, antibiotics, and implant retention (DAIR) is an established treatment modality in periprosthetic joint infections (PJIs), but success rates vary. This study compared the success of DAIR for PJIs after a total hip arthroplasty (THA), with or without local antibiotic delivery with CaSO $_{4}$ as the carrier material. Methods: A retrospective review of DAIR for PJIs after THA performed between 2010 and 2018, including 41 patients is conducted. A total of 27 patients were treated by DAIR with local antibiotics with CaSO $_{4}$ as the carrier material, and 14 patients were treated by a standard DAIR. The endpoints were treatment failure, defined as the need for a reoperation, either a second DAIR or a prosthesis removal or exchange due to persistent or recurrent infection, the initiation of a long-term suppressive antibiotic treatment, or death related to infection. Results: Considering any reoperation as an outcome, 11 of 14 cases treated without AB-CaSO $_{4}$ (79 %) and 4 of the 27 cases treated with AB-CaSO $_{4}$ failed (15 %). Considering revision as an outcome, 9 out of 14 cases treated without AB-CaSO $_{4}$ (64 %) and 4 of the 27 cases treated with AB-CaSO $_{4}$ (15 %) failed. A Kaplan-Meier survival analysis showed that local antibiotic delivery with CaSO $_{4}$ as the carrier material led to a significantly longer infection-free survival, considering any surgical revision ( $p < 0.0001$ ; hazard ratio 8.9 (95 % CI 2.8-28.2)) or revision with component exchange ( $p = 0.0015$ ; hazard ratio 5.6 (95 % CI 1.7-18.2)) as the endpoint. Conclusion: The addition of local antibiotics with CaSO $_{4}$ as the carrier material to DAIR for PJIs after THA significantly increases success rates, such as infection-free survival, any reoperation, and revision with component exchange in particular.