Abstract

Background

Following concerns regarding the emergence of Clostridium difficile infection in 2010, we changed antibiotic prophylaxis in patients undergoing primary hip and knee arthroplasty from cefuroxime to flucloxacillin and single-dose (SD) gentamicin. A subsequent perceived increase in the incidence of post-operative acute kidney injury (AKI) led us to evaluate the AKI incidence between different prophylactic antibiotic regimes used at our centre.

Methods

We examined the incidence of AKI as defined by Kidney Disease: Improving Global Outcomes criteria in 1588 patients undergoing primary hip or knee arthroplasty from January 2010 to January 2015. Patients received the following prophylactic antibiotic regimes: 8 g flucloxacillin in four divided doses and SD gentamicin 1.5 mg/kg ideal body weight (IBW; maximum dose 120 mg; n = 400), 8 g flucloxacillin alone in four divided doses (n = 400), SD cefuroxime (n = 400), triple-dose (TD) cefuroxime (n = 188) and teicoplanin with SD gentamicin 1.5 mg/kg IBW (n = 200).

Results

The incidence of AKI was as follows: flucloxacillin and gentamicin (13%); flucloxacillin alone (8.5%); SD cefuroxime (2%); TD cefuroxime (0.5%); and teicoplanin and gentamicin (3%). Of the six patients who developed Stage 3 AKI, all were in the flucloxacillin and gentamicin group. The odds ratio for the development of AKI derived from a binary logistic regression model was highest in the flucloxacillin and gentamicin group [7.79 (95% confidence interval 3.54–17.14), P < 0.0001].

Conclusions

Our findings suggest that the use of prophylactic high-dose flucloxacillin and gentamicin should be used with caution in patients undergoing primary hip or knee arthroplasty without a clear advantage in reducing surgical site infections given the association with increased rates of AKI.

中文翻译：

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初次髋膝关节置换术中预防性氟氯西林和庆大霉素后的急性肾损伤

摘要

背景

由于对 2010 年出现艰难梭菌感染的担忧，我们将接受初次髋关节和膝关节置换术的患者的抗生素预防从头孢呋辛改为氟氯西林和单剂量 (SD) 庆大霉素。随后感知到的术后急性肾损伤 (AKI) 发生率增加，这使我们评估了我们中心使用的不同预防性抗生素方案之间的 AKI 发生率。

方法

我们在 2010 年 1 月至 2015 年 1 月期间检查了 1588 名接受初次髋关节或膝关节置换术的患者的肾脏疾病定义的 AKI 发病率：改善全球结果标准。患者接受了以下预防性抗生素方案：8 g 氟氯西林分四次服用和 SD 庆大霉素1.5 mg/kg 理想体重（IBW；最大剂量 120 mg；n  = 400），单独 8 g 氟氯西林，分四次服用（n  = 400），SD 头孢呋辛（n  = 400），三剂量（TD）头孢呋辛（n  = 188) 和替考拉宁与 SD 庆大霉素 1.5 mg/kg IBW ( n  = 200)。

结果

AKI的发生率如下：氟氯西林和庆大霉素（13%）；单独使用氟氯西林（8.5%）；SD头孢呋辛（2%）；TD头孢呋辛（0.5%）；和替考拉宁和庆大霉素（3%）。在发生 3 期 AKI 的 6 名患者中，所有患者都在氟氯西林和庆大霉素组。从二元逻辑回归模型得出的 AKI 发展的优势比在氟氯西林和庆大霉素组中最高 [7.79（95% 置信区间 3.54-17.14），P < 0.0001]。

结论

我们的研究结果表明，鉴于与 AKI 发生率增加相关，在初次髋关节或膝关节置换术的患者中应谨慎使用预防性大剂量氟氯西林和庆大霉素，但在减少手术部位感染方面没有明显优势。