假体周围感染使用抗生素骨水泥出现肾损伤的文献分析

Literature analysis on renal injury caused by antibiotic bone cement in the treatment of periprosthetic infection

目的了解假体周围感染(PJI)使用抗生素骨水泥出现肾损伤的情况。方法检索PubMed、Elsevier Science Direct、Embase、Springer-link、Wiley Online Library、中国知网及万方数据库,检索时间为数据库建库至2020年2月,收集期刊文献报道关于PJI使用抗生素骨水泥出现肾损伤的研究,提取相关数据进行描述性统计分析。结果共收集到PJI使用抗生素骨水泥出现肾损伤患者10例,其中男性3例,女性7例。平均年龄75岁。3例患者术前血肌酐>106.08μmol/L。8例患者负载抗生素品种>1种。骨水泥负载抗生素最常见品种为妥布霉素,总剂量范围为3.6~8.0 g。9例患者记录了全身用抗生素情况,联合用药4例。9例患者血肌酐升高中位时间为7 d。后经不同处理后,7例患者28~91 d血肌酐有不同程度恢复。根据Naranjo评分,4例患者出现肾损伤被认为与抗生素骨水泥的关联性为可能。结论PJI使用抗生素骨水泥可能会出现肾损伤,需引起临床重视。

Objective This study was designed to investigate the renal injury caused by antibiotic bone cement in patients with peri-prosthetic infection.Methods The databases of PubMed,Elsevier Science Direct,Embase,Springer-link,Wiley Online Library,CNKI and Wanfang(up to February 2020)were searched,and the literatures about acute renal injury caused by antibiotic bone cement in the treatment of periprosthetic infection were collected,and the relevant data were extracted for descriptive statistical analysis.Results A total of 10 patients with renal injury caused by antibiotic bone cement in the treatment of periprosthetic infection were collected,including 3 males and 7 females with an average age of 75 years old.Serum creatinine levels were higher than 106.08μmol/L in 3 patients before operation.8 patients were loaded with more than one kind of antibiotics.Tobramycin is the most common antibiotic loaded with bone cement,and the total dose range from 3.6-8.0 g.Systemic use of antibiotics was recorded in 9 patients and combined use of antibiotics in 4 cases.The median time of elevated serum creatinine levels in 9 patients was 7 days.Creatinine recovery time was recorded in 7 patients,and creatinine recovered in varying degrees from 28 days to 91 days.According to the Naranjo score,4 patients thought that the relationship between antibiotic bone cement and renal injury was possible.Conclusion The use of antibiotic bone cement in periprosthetic infection is likely to cause renal injury,which needs clinical attention.