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
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摘要
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.
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.
引文
[1]Parvizi J,Adeli B,Zmistowski B,et al.Management of periprosthetic joint infection:the current knowledge:AAOSexhibit selection.J Bone Joint Surg Am.2012;94(14):e104.
[2]Tsung JD,Rohrsheim JA,Whitehouse SL,et al.Management of periprosthetic joint infection after total hip arthroplasty using a custom made articulating spacer(CUMARS);the Exeter experience.J Arthroplasty.2014;29(9):1813-1818.
[3]Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from2005 to 2030.J Bone Joint Surg Am.2007;89(4):780-785.
[4]Hall AJ.Late infection about a total knee prosthesis.Report of a case secondary to urinary tract infection.J Bone Joint Surg Br.1974;56(1):144-147.
[5]Irvine R,Johnson BL Jr,Amstutz HC.The relationship of genitourinary tract procedures and deep sepsis after total hip replacements.Surg Gynecol Obstet.1974;139(5):701-706.
[6]Wilson PD Jr,Salvati EA,Blumenfeld EL.The problem of infection in total prosthetic arthroplasty of the hip.Surg Clin North Am.1975;55(6):1431-1437.
[7]Uckay I,Lubbeke A,Huttner B.Preoperative asymptomatic bacteriuria and subsequent prosthetic joint infection:lack of a causal relation.Clin Infect Dis.2014;59(10):1506-1507.
[8]Glynn MK,Sheehan JM.The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty.Clin Orthop Relat Res.1984;(185):151-154.
[9]Honkanen M,J?msen E,Karppelin M,et al.The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement:a retrospective study with a 1-year follow up.Clin Microbiol Infect.2018;24(4):376-380.
[10]王永成,牛啸博,张新宇,等.无症状菌尿与关节置换术后假体周围感染的相关性研究[J].中华关节外科杂志(电子版),2017,11(4):379-382.
[11]Weale R,El-Bakri F,Saeed K.Pre-operative asymptomatic bacteriuria:a risk factor for prosthetic joint infection?J Hosp Infect.2019;101(2):210-213.
[12]Cota GF,de Sousa MR,Fereguetti TO,et al.Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIVinfected patients:a systematic review with indirect comparison.PLoS Negl Trop Dis.2013;7(5):e2195.
[13]陈泽鑫,刘慧,潘益峰,等.试验性和观察性研究相关医学文献质量评价方法[J].中国循证医学杂志,2011,11(11):1229-1236.
[14]Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses.BMJ(Clinical research ed).2003;327(7414):557-560.
[15]Bouvet C,Lubbeke A,Bandi C,et al.Is there any benefit in pre-operative urinary analysis before elective total joint replacement?Bone Joint J.2014;96-b(3):390-394.
[16]Cordero-Ampuero J,Gonzalez-Fernandez E,Martinez-Velez D,et al.Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria?Seeding risk with/without treatment.Clin Orthop Relat Res.2013;471(12):3822-3829.
[17]Martínez-Vélez D,González-Fernández E,Esteban J,et al.Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection.Eur JOrthop Surg Traumatol.2016;26(2):209-214.
[18]Ritter MA,Fechtman RW.Urinary tract sequelae:possible influence on joint infections following total joint replacement.Orthopedics.1987;10(3):467-469.
[19]Sousa R,Mu?oz-Mahamud E,Quayle J,et al.Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?Clin Infect Dis.2014;59(1):41-47.
[20]David TS,Vrahas MS.Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty.J Am Acad Orthop Surg.2000;8(1):66-74.
[21]Singh H,Thomas S,Agarwal S,et al.Total knee arthroplasty in women with asymptomatic urinary tract infection.J Orthop Surg(Hong Kong).2015;23(3):298-300.
[22]Ollivere BJ,Ellahee N,Logan K,et al.Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery.Int Orthop.2009;33(3):847-850.
[23]Koulouvaris P,Sculco P,Finerty E,et al.Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty.Clin Orthop Relat Res.2009;467(7):1859-1867.
[24]Stamm WE,Hooton TM,Johnson JR,et al.Urinary tract infections:from pathogenesis to treatment.J Infect Dis.1989;159(3):400-406.
[25]万里燕,崔建,袁丽萍,等.成人无症状性菌尿诊断和治疗指南[J].世界临床药物,2006,27(10):582-584.
[26]Nicolle LE.Asymptomatic bacteriuria.Curr Opin Infect Dis.2014;27(1):90-96.
[27]Harbour R,Lowe G,Twaddle S.Scottish Intercollegiate Guidelines Network:the first 15 years(1993-2008).J R Coll Physicians Edinb.2011;41(2):163-168.
[2]Tsung JD,Rohrsheim JA,Whitehouse SL,et al.Management of periprosthetic joint infection after total hip arthroplasty using a custom made articulating spacer(CUMARS);the Exeter experience.J Arthroplasty.2014;29(9):1813-1818.
[3]Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from2005 to 2030.J Bone Joint Surg Am.2007;89(4):780-785.
[4]Hall AJ.Late infection about a total knee prosthesis.Report of a case secondary to urinary tract infection.J Bone Joint Surg Br.1974;56(1):144-147.
[5]Irvine R,Johnson BL Jr,Amstutz HC.The relationship of genitourinary tract procedures and deep sepsis after total hip replacements.Surg Gynecol Obstet.1974;139(5):701-706.
[6]Wilson PD Jr,Salvati EA,Blumenfeld EL.The problem of infection in total prosthetic arthroplasty of the hip.Surg Clin North Am.1975;55(6):1431-1437.
[7]Uckay I,Lubbeke A,Huttner B.Preoperative asymptomatic bacteriuria and subsequent prosthetic joint infection:lack of a causal relation.Clin Infect Dis.2014;59(10):1506-1507.
[8]Glynn MK,Sheehan JM.The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty.Clin Orthop Relat Res.1984;(185):151-154.
[9]Honkanen M,J?msen E,Karppelin M,et al.The impact of preoperative bacteriuria on the risk of periprosthetic joint infection after primary knee or hip replacement:a retrospective study with a 1-year follow up.Clin Microbiol Infect.2018;24(4):376-380.
[10]王永成,牛啸博,张新宇,等.无症状菌尿与关节置换术后假体周围感染的相关性研究[J].中华关节外科杂志(电子版),2017,11(4):379-382.
[11]Weale R,El-Bakri F,Saeed K.Pre-operative asymptomatic bacteriuria:a risk factor for prosthetic joint infection?J Hosp Infect.2019;101(2):210-213.
[12]Cota GF,de Sousa MR,Fereguetti TO,et al.Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIVinfected patients:a systematic review with indirect comparison.PLoS Negl Trop Dis.2013;7(5):e2195.
[13]陈泽鑫,刘慧,潘益峰,等.试验性和观察性研究相关医学文献质量评价方法[J].中国循证医学杂志,2011,11(11):1229-1236.
[14]Higgins JP,Thompson SG,Deeks JJ,et al.Measuring inconsistency in meta-analyses.BMJ(Clinical research ed).2003;327(7414):557-560.
[15]Bouvet C,Lubbeke A,Bandi C,et al.Is there any benefit in pre-operative urinary analysis before elective total joint replacement?Bone Joint J.2014;96-b(3):390-394.
[16]Cordero-Ampuero J,Gonzalez-Fernandez E,Martinez-Velez D,et al.Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria?Seeding risk with/without treatment.Clin Orthop Relat Res.2013;471(12):3822-3829.
[17]Martínez-Vélez D,González-Fernández E,Esteban J,et al.Prevalence of asymptomatic bacteriuria in knee arthroplasty patients and subsequent risk of prosthesis infection.Eur JOrthop Surg Traumatol.2016;26(2):209-214.
[18]Ritter MA,Fechtman RW.Urinary tract sequelae:possible influence on joint infections following total joint replacement.Orthopedics.1987;10(3):467-469.
[19]Sousa R,Mu?oz-Mahamud E,Quayle J,et al.Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?Clin Infect Dis.2014;59(1):41-47.
[20]David TS,Vrahas MS.Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty.J Am Acad Orthop Surg.2000;8(1):66-74.
[21]Singh H,Thomas S,Agarwal S,et al.Total knee arthroplasty in women with asymptomatic urinary tract infection.J Orthop Surg(Hong Kong).2015;23(3):298-300.
[22]Ollivere BJ,Ellahee N,Logan K,et al.Asymptomatic urinary tract colonisation predisposes to superficial wound infection in elective orthopaedic surgery.Int Orthop.2009;33(3):847-850.
[23]Koulouvaris P,Sculco P,Finerty E,et al.Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty.Clin Orthop Relat Res.2009;467(7):1859-1867.
[24]Stamm WE,Hooton TM,Johnson JR,et al.Urinary tract infections:from pathogenesis to treatment.J Infect Dis.1989;159(3):400-406.
[25]万里燕,崔建,袁丽萍,等.成人无症状性菌尿诊断和治疗指南[J].世界临床药物,2006,27(10):582-584.
[26]Nicolle LE.Asymptomatic bacteriuria.Curr Opin Infect Dis.2014;27(1):90-96.
[27]Harbour R,Lowe G,Twaddle S.Scottish Intercollegiate Guidelines Network:the first 15 years(1993-2008).J R Coll Physicians Edinb.2011;41(2):163-168.
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