目的:使用克林霉素进行全身抗生素预防,常用于青霉素或头孢菌素过敏患者,在初次全膝关节置换术(TKR)中,与氯唑西林相比,深部人工关节感染(PJI)的手术翻修风险更高。我们旨在调查在原发性胶结TKR中,与头孢菌素相比,克林霉素是否会增加PJI引起的手术翻修风险。
方法:纳入了2005-2020年挪威关节成形术登记册(NAR)中59,081TKR的数据。2,655(5%)接受克林霉素,56,426(95%)接受头孢菌素。Cox回归分析进行了性别调整,年龄组,诊断,和ASA得分。使用Kaplan-Meier估计计算生存时间,并使用Cox回归与PJI修订作为终点进行比较。还比较了头孢菌素头孢洛素和头孢唑啉。
结果:在包括的TKR中,1.3%(n=743)的PJI进行了修订。96%(n=713)接受了头孢菌素和4%(n=30)克林霉素用于围手术期预防。比较头孢菌素(参考)和克林霉素,在3个月随访时,PJI的校正风险比率(HRR)为0.7(95%置信区间[CI]0.4-1.4),在1年0.9(CI0.6-1.5),和5年0.9(CI0.6-1.4)。使用倾向评分匹配的分析显示出相似的结果。此外,比较头孢霉素(参考)和头孢唑林,3个月时HRR为1.0(CI0.8-1.4),1年时HRR为1.0(CI0.7-1.3)。
结论:我们发现在原发性胶结TKRs中使用克林霉素与头孢菌素相比,PJI的修订风险没有差异。在青霉素或头孢菌素过敏患者中继续使用克林霉素似乎是安全的。
Systemic antibiotic prophylaxis with clindamycin, which is often used in penicillin- or cephalosporin-allergic patients\', has been associated with a higher risk of surgical revision for deep prosthetic joint infection (PJI) than cloxacillin in primary total knee replacement (TKR). We aimed to investigate whether clindamycin increases the risk of surgical revisions due to PJI compared with cephalosporins in primary cemented TKR.
Data from 59,081 TKRs in the Norwegian Arthroplasty Register (NAR) 2005-2020 was included. 2,655 (5%) received clindamycin and 56,426 (95%) received cephalosporins. Cox regression analyses were performed with adjustment for sex, age groups, diagnosis, and ASA score. Survival times were calculated using Kaplan-Meier estimates and compared using Cox regression with revision for PJI as endpoint. The cephalosporins cefalotin and cefazolin were also compared.
Of the TKRs included, 1.3% (n = 743) were revised for PJI. 96% (n = 713) had received cephalosporins and 4% (n = 30) clindamycin for perioperative prophylaxis. Comparing cephalosporins (reference) and clindamycin, at 3-month follow-up the adjusted hazard ratio rate (HRR) for PJI was 0.7 (95% confidence interval [CI] 0.4-1.4), at 1 year 0.9 (CI 0.6-1.5), and at 5 years 0.9 (CI 0.6-1.4). Analysis using propensity score matching showed similar results. Furthermore, comparing cefalotin (reference) and cefazolin, HRR was 1.0 (CI 0.8-1.4) at 3 months and 1.0 (CI 0.7-1.3) at 1-year follow-up.
We found no difference in risk of revision for PJI when using clindamycin compared with cephalosporins in primary cemented TKRs. It appears safe to continue the use of clindamycin in penicillin- or cephalosporin-allergic patients.