Abstract：
BACKGROUND: There is growing interest in extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA); however, the benefit of EAP remains controversial. For this investigation, both oral and intravenous antibiotic protocols were included in the EAP group.
METHODS: The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, Ovid Embase, Elton B. Stephens CO, and Cumulative Index to Nursing and Allied Health Literature were queried for literature comparing outcomes of primary and aseptic revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients who were treated with either ≤24 hours of postoperative antibiotic prophylaxis (standard of care [SoC]) or >24 hours of EAP. The primary outcome was periprosthetic joint infection (PJI). A pooled relative-risk random-effects Mantel-Haenszel model was implemented to compare cohorts.
RESULTS: There were 18 studies with a total of 19,153 patients included. There was considerable variation in antibiotic prophylaxis protocols with first-generation cephalosporins being the most commonly implemented antibiotic for both groups. Patients treated with EAP were 35% less likely to develop PJI relative to the SoC (P = .0004). When examining primary TJA, patients treated with EAP were 39% and 40% less likely to develop a PJI for TJA (P = .0008) and THA (P = .02), respectively. There was no significant difference for primary TKA (P = .17). When examining aseptic revision TJA, EAP led to a 36% and 47% reduction in the probability of a PJI for aseptic revision TJA (P = .007) and aseptic revision TKA (P = .008), respectively; there was no observed benefit for aseptic revision THA (P = .36).
CONCLUSIONS: This meta-analysis demonstrated that patients treated with EAP were less likely to develop a PJI relative to those treated with the SoC for all TJA, primary TJA, primary THA, aseptic revision TJA, and aseptic revision TKA. There was no significant difference observed between EAP and SoC for primary TKA or aseptic revision THA.
METHODS: The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, Ovid Embase, Elton B. Stephens CO, and Cumulative Index to Nursing and Allied Health Literature were queried for literature comparing outcomes of primary and aseptic revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients who were treated with either ≤24 hours of postoperative antibiotic prophylaxis (standard of care [SoC]) or >24 hours of EAP. The primary outcome was periprosthetic joint infection (PJI). A pooled relative-risk random-effects Mantel-Haenszel model was implemented to compare cohorts.
RESULTS: There were 18 studies with a total of 19,153 patients included. There was considerable variation in antibiotic prophylaxis protocols with first-generation cephalosporins being the most commonly implemented antibiotic for both groups. Patients treated with EAP were 35% less likely to develop PJI relative to the SoC (P = .0004). When examining primary TJA, patients treated with EAP were 39% and 40% less likely to develop a PJI for TJA (P = .0008) and THA (P = .02), respectively. There was no significant difference for primary TKA (P = .17). When examining aseptic revision TJA, EAP led to a 36% and 47% reduction in the probability of a PJI for aseptic revision TJA (P = .007) and aseptic revision TKA (P = .008), respectively; there was no observed benefit for aseptic revision THA (P = .36).
CONCLUSIONS: This meta-analysis demonstrated that patients treated with EAP were less likely to develop a PJI relative to those treated with the SoC for all TJA, primary TJA, primary THA, aseptic revision TJA, and aseptic revision TKA. There was no significant difference observed between EAP and SoC for primary TKA or aseptic revision THA.
摘要：
背景：在全关节置换术（TJA）后，人们对延长抗生素预防（EAP）越来越感兴趣；然而，EAP的好处仍然存在争议。为了这次调查,EAP组包括口服和静脉(IV)抗生素方案.
方法：Cochrane系统评价数据库，Cochrane受控试验登记册,PubMed,MEDLINE,WebofScience,OvidEmbase,EBSCO,和CINAHL查询文献比较了初次和无菌翻修全髋关节置换术（THA）和全膝关节置换术（TKA）患者的结局，这些患者接受了≤24小时的术后抗生素预防（标准护理，SoC）或>24小时的EAP。主要结果是人工关节感染（PJI）。实施了合并的相对风险随机效应Mantel-Haenszel模型来比较队列。
结果：共纳入18项研究，共19,153名患者。抗生素预防方案存在相当大的差异，第一代头孢菌素是两组最常用的抗生素。与SoC相比，用EAP治疗的患者发生PJI的可能性降低了35%(P=0.0004)。检查主要TJA时，接受EAP治疗的患者发生TJA（P=0.0008）和THA（P=0.02）的PJI的可能性分别降低了39％和40％，分别。原发性TKA差异无统计学意义(P=0.17)。检查无菌翻修TJA时，EAP导致无菌翻修TJA（P=0.007）和无菌翻修TKA（P=0.008）的PJI概率降低了36％和47％，分别；没有观察到无菌翻修THA的益处（P=0.36）。
结论：这项荟萃分析表明，与所有TJA接受SoC治疗的患者相比，接受EAP治疗的患者发生PJI的可能性较小，主要的TJA,主要的THA,无菌翻修TJA,和无菌翻修TKA。对于主要TKA或无菌翻修THA，EAP和SoC之间没有显着差异。
方法：Cochrane系统评价数据库，Cochrane受控试验登记册,PubMed,MEDLINE,WebofScience,OvidEmbase,EBSCO,和CINAHL查询文献比较了初次和无菌翻修全髋关节置换术（THA）和全膝关节置换术（TKA）患者的结局，这些患者接受了≤24小时的术后抗生素预防（标准护理，SoC）或>24小时的EAP。主要结果是人工关节感染（PJI）。实施了合并的相对风险随机效应Mantel-Haenszel模型来比较队列。
结果：共纳入18项研究，共19,153名患者。抗生素预防方案存在相当大的差异，第一代头孢菌素是两组最常用的抗生素。与SoC相比，用EAP治疗的患者发生PJI的可能性降低了35%(P=0.0004)。检查主要TJA时，接受EAP治疗的患者发生TJA（P=0.0008）和THA（P=0.02）的PJI的可能性分别降低了39％和40％，分别。原发性TKA差异无统计学意义(P=0.17)。检查无菌翻修TJA时，EAP导致无菌翻修TJA（P=0.007）和无菌翻修TKA（P=0.008）的PJI概率降低了36％和47％，分别；没有观察到无菌翻修THA的益处（P=0.36）。
结论：这项荟萃分析表明，与所有TJA接受SoC治疗的患者相比，接受EAP治疗的患者发生PJI的可能性较小，主要的TJA,主要的THA,无菌翻修TJA,和无菌翻修TKA。对于主要TKA或无菌翻修THA，EAP和SoC之间没有显着差异。
