关节置换围术期无症状性菌尿应用抗生素治疗必要性的Meta分析

Whether antibiotic treatment is necessary for treating asymptomatic bacteriuria in the perioperative period of joint arthroplasty: a meta-analysis

背景:关节假体周围感染是关节置换后灾难性的并发症。临床上针对关节置换围术期无症状性菌尿会选择口服抗生素治疗,但既往研究针对无症状性菌尿是否会引起关节假体周围感染尚无统一定论,抗生素的疗效也不得而知。目的:通过Meta分析研究无症状性菌尿是否是引起关节假体周围感染的危险因素及抗生素治疗是否有效。方法:系统检索主要外文和中文数据库,例如PubMed、Ovid、Cochrane图书馆、EMBASE、CNKI、万方、维普数据库、CMB等,并通过手工检索、文献溯源等查找建库至2018年5月研究无症状性菌尿对关节置换预后影响的文章。根据Cochrane系统评价方法进行筛选文献筛选、质量评价、数据提取,使用Review Manager 5.3软件进行分析。结果与结论:①共纳入9篇文献,共计29 844例关节置换的病例,其中合并无症状性菌尿的病例共2 366例;②相比于非无症状性菌尿组,关节假体周围感染在无症状性菌尿组中的发病率更高,差异有显著性意义(OR=3.15,95%CI:1.23-8.02,P=0.02);③9篇中有7篇文献报道了抗生素使用于治疗围术期无症状菌尿,抗生素组及抗生素未使用组关节假体周围感染发病率差异无显著性意义(OR=1.64,95%CI:0.84-3.23,P=0.15);④提示关节置换围术期无症状性菌尿的发生是假体关节周围感染的危险因素,而针对无症状性菌尿的抗生素使用与否并不会改变关节假体周围感染的发生率。

BACKGROUND: Periprosthetic joint infection is a serious and catastrophic complication after joint arthroplasty. For asymptomatic bacteriuria, during perioperative period of joint arthroplasty, many doctors choose oral antibiotics. However, the previous research on whether asymptomatic bacteriuria will cause periprosthetic joint infection has no consensus, and the effect of antibiotics is unknown.OBJECTIVE: To investigate whether asymptomatic bacteriuria is a risk factor for periprosthetic joint infection and whether antibiotic treatment is effective by meta-analysis. METHODS: Through systematic research based on computer of major foreign and Chinese databases, such as PubMed, Ovid, Cochrane Library, EMBASE, CNKI, WanFang, VIP, and CMB databases, and manual research, literature traceability was performed. The articles concerning the effect of asymptomatic bacteriuria on the prognosis of joint arthroplasty published before May 2018 was searched. Literature screening, quality evaluation and data extraction were performed according to the Cochrane system, and analysis was undergone on Review Manager 5.3 software. RESULTS AND CONCLUSION:(1) Nine articles were enrolled, involving 29 844 cases of joint arthroplasty, including 2 366 cases of asymptomatic bacteriuria.(2) Periprosthetic joint infection had a significantly higher incidence in the asymptomatic bacteriuria group than that in the non-asymptomatic bacteriuria group (OR=3.15, 95%CI: 1.23-8.02, P=0.02).(3) Seven in the nine articles reported the use of antibiotics for treating perioperative asymptomatic bacteriuria, and there was no significant difference in the incidence of periprosthetic joint infection between two groups (OR=1.64, 95%CI: 0.84-3.23, P=0.15).(4) To conclude, the occurrence of asymptomatic bacteriuria in the perioperative period of joint arthroplasty is a risk factor for periprosthetic joint infection, and the use of antibiotics for asymptomatic bacteriuria does not change the incidence of periprosthetic joint infection.