The Use and Adverse Effects of Oral and Intravenous Antibiotic Administration for Suspected Infection After Revision Shoulder Arthroplasty
| Autor: | Jason E. Hsu, Jie J. Yao, Anastasia J. Whitson, Frederick A. Matsen, Benjamin M. Woodhead, Kevin Jurgensmeier, Paul S. Pottinger |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Prosthesis-Related Infections medicine.drug_class medicine.medical_treatment Antibiotics Administration Oral Risk Assessment 03 medical and health sciences 0302 clinical medicine Clinical Protocols Internal medicine Antibiotic therapy medicine Humans Orthopedics and Sports Medicine Adverse effect Aged Retrospective Studies 030222 orthopedics Univariate analysis business.industry Level iv Retrospective cohort study 030229 sport sciences General Medicine Middle Aged Arthroplasty Anti-Bacterial Agents Arthroplasty Replacement Shoulder Intravenous antibiotics Surgery Administration Intravenous Female business |
| Zdroj: | The Journal of bone and joint surgery. American volume. 102(11) |
| ISSN: | 1535-1386 |
| Popis: | BACKGROUND When performing revision shoulder arthroplasty, surgeons do not have access to the results of intraoperative culture specimens and will administer empiric antibiotics to cover for the possibility of deep infection until the culture results are finalized. The purpose of this study was to report the factors associated with the initiation, modification, and adverse events of 2 different postoperative antibiotic protocols in a series of revision shoulder arthroplasties. METHODS In this study, 175 patients undergoing revision shoulder arthroplasty were treated with either a protocol of intravenous (IV) antibiotics if there was a high index of suspicion for infection or a protocol of oral antibiotics if the index of suspicion was low. Antibiotics were withdrawn if cultures were negative and were modified as indicated if the cultures were positive. Antibiotic course, modification, and adverse effects to antibiotic administration were documented. RESULTS On univariate analysis, factors significantly associated with the initiation of IV antibiotics were male sex (p < 0.001), history of infection (p < 0.001), intraoperative humeral loosening (p = 0.003), and membrane formation (p < 0.001). On multivariate analysis, male sex (p = 0.003), history of infection (p = 0.003), and membrane formation (p < 0.001) were found to be independent predictors of the initiation of IV antibiotics. On the basis of preoperative and intraoperative characteristics, surgeons anticipated the culture results in 75% of cases, and modification of antibiotic therapy was required in 25%. The modification from oral to IV antibiotics due to positive culture results was made significantly more often in male patients (p < 0.001). Adverse effects of antibiotic administration occurred in 19% of patients. The rates of complications were significantly lower in the patients treated with oral antibiotics and a shorter course of antibiotics (p < 0.001). CONCLUSIONS Complications associated with antibiotic administration after revision shoulder arthroplasty are not infrequent and are more common in patients whose initial protocol is IV antibiotics. Further study is needed to balance the effectiveness and risks of post-revision antibiotic treatment given the frequency of antibiotic-related complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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