全髋及全膝关节置换后假体周围感染抗生素应用方案研究进展

Advances in the application of antibiotics for periprosthetic joint infection after total knee and hip arthroplasties

背景:假体周围感染是全髋和全膝关节置换术后最可怕的并发症。在假体周围感染的治疗期间抗生素的使用必不可少,但目前医学届对髋膝关节置换后假体周围感染抗生素的管理,即其具体使用时机、时长暂无定论,最佳的应用疗程、剂量、使用时机及给药途径尚需进一步探讨。目的:对国内外治疗假体周围感染过程中使用抗生素的近期研究进展进行综述,以求为临床上全髋、全膝关节置换后假体周围感染抗菌治疗提供一定的参考。方法:全面检索2002至2018年CBMdisc、CNKI、VIP、万方资源数据库收录的文献和PubMed、Embase、Web of Science数据库,检索词分别为"关节置换术,术后感染,抗生素"以及"knee,hip,arthroplasty,infect,antibiotics",将语言分别设定为中文和英文。从全髋和全膝关节置换后假体周围感染的流行病学、诊断标准、治疗手段等方面入手,对临床上治疗假体周围感染期间抗生素的使用情况进行全方位的剖析与总结。结果与结论:(1)全文共计纳入47篇文献;(2)结果表明,假体周围感染治疗期间抗生素的使用时机、最佳的应用疗程、剂量及给药途径目前学界仍缺乏统一的执行标准。目前绝大多数的研究都仅说明了术后使用抗生素选择及联合用药的重要性,具体疗程、给药方式、使用剂量尚无定论;(3)临床上假体周围感染抗生素的使用大多依据专家共识或专家经验,缺乏高等级循证医学证据指导;(4)因此,急需进行相关的循证及临床随机对照试验研究,为临床上全髋和全膝关节置换后假体周围感染抗生素的使用管理提供较高质量、且确切有效的循证医学证据支持,进而为骨科医生的临床决策提供参考。

BACKGROUND:Periprosthetic joint infection is the severest complication after total hip and knee arthroplasties.Antibiotics are essential for periprosthetic joint infection.However,the administration of antibiotics for periprosthetic joint infection after hip and knee arthroplasties,such as usage timing,optimal treatment course,and administration ways needs a further investigation.OBJECTIVE:To summarize the research progress of antibiotics used in the treatment of periprosthetic joint infection at home and abroad,in order to provide reference for the antibiotic treatment of periprosthetic joint infection after total hip and knee arthroplasties.METHODS:Comprehensive search of CBMdisc,CNKI,VIP,and WanFang,PubMed,Embase,and Web of Science databases from 2002 to 2018 was performed.The key words were“joint replacement,postoperative infections,antibiotics”and“knee,hip,arthroplasty,infect,antibiotics”in Chinese and English,respectively.The epidemiology,diagnostic criteria,and treatment methods of periprosthetic joint infection after total hip and knee arthroplasties,as well as usage of antibiotics were summarized.RESULTS AND CONCLUSION:(1)Forty-seven articles were included.(2)There is still a lack of uniform standards for the use timing,optimal treatment course,dosage and administration ways of antibiotics for periprosthetic joint infection.Most of studies only show the importance of the choice of antibiotics and combination therapy postoperatively.The specific treatment course,administration ways,and doses are unclear.(3)Use of antibiotics for periprosthetic joint infection is mostly based on expert consensus or experience,and there is no high-quality evidence-based medicine.(4)Therefore,relevant evidence-based and randomized controlled trials are needed to provide high-quality,accurate and effective evidence-based medicine for the management of antibiotic use after total hip and knee arthroplasties,and thus providing reference for clinical practice.