Efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Peihua ¹ , LU Fei ¹ ,  ZONG Zhiyong ^1,2

1. Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, P.R.China;
2. Department of Infection Control, West Hospital of Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

ZONG Zhiyong, Email: zongzhiy@scu.edu.cn

Keywords：

Arthroscopy; Antimicrobial prophylaxis; Infection; Meta-analysis; Systematic review; Cohort study; Randomized controlled trial

DOI：

10.7507/1672-2531.202010009

Video：

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Objectives To systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.Methods PubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.Results A total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).Conclusions Current evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： WANG Peihua, LU Fei, ZONG Zhiyong. Efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1397-1402. doi: 10.7507/1672-2531.202010009 Copy

1.	Jain NB, Higgins LD, Losina E, et al. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskel Dis, 2014, 15: 4.
2.	Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am, 2011, 93(11): 994-1000.
3.	De Luca A, Green W, Canobbio M, et al. Strategies to effectively prevent surgical site infections in Italian hospitals: economic benefits. Value Health, 2017, 20(9): A782.
4.	D'Angelo GL, Ogilvie-Harris DJ. Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis. Arthroscopy, 1988, 4(1): 10-14.
5.	抗菌药物临床应用指导原则修订工作组. 抗菌药物临床应用指导原则: 2015 年版. 北京: 人民卫生出版社, 2015.
6.	Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt), 2013, 14(1): 73-156.
7.	Anil U, Badri A, Pham H, et al. Perioperative antibiotic utilization by orthopedic surgeons in arthroscopic surgery a survey of practice patterns. Bull Hosp Jt Dis, 2020, 78(2): 97-100.
8.	Marmor S, Farman T, Lortat-Jacob A. Joint infection after knee arthroscopy: medicolegal aspects. Orthop Traumatol Surg Res, 2009, 95(4): 278-283.
9.	Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg, 2008, 16(5): 283-293.
10.	Marks M, Bell LCK, Jones I, et al. Clinical and economic impact of implementing OVIVA criteria on patients with bone and joint infections in outpatient parenteral antimicrobial therapy. Clin Infect Dis, 2020, 71(1): 207-210.
11.	Kurzweil PR. Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy, 2006, 22(4): 452-454.
12.	Baraza N, Leith J. Are prophylactic intravenous antibiotics required in routine shoulder arthroscopic surgery? A systematic review of the literature. Joints, 2018, 6(1): 54-57.
13.	Mader JT, Cierny G. The principles of the use of preventive antibiotics. Clin Orthop Relat Res, 1984, (190): 75-82.
14.	Tarchini G, Liau KH, Solomkin JS. Antimicrobial stewardship in surgery: challenges and opportunities. Clin Infect Dis, 2017, 64(suppl_2): S112-S114.
15.	Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control, 1999, 27(2): 97-132.
16.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0), 2011. Available at: https://training.cochrane.org/handbook/archive/v5.1/.
18.	Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy, 2007, 23(1): 4-6.
19.	Hoel RJ, Mittelsteadt MJ, Samborski SA, et al. Preoperative antibiotics in wrist arthroscopy. J Hand Surg Am, 2018, 43(11): 987-991.
20.	Naqvi GA, Jahangiri S, Malik SA, et al. Prophylactic antibiotics for elective knee arthroscopy: Do we really need it? Irish J Med Sci, 2011, 180: S101-S102.
21.	Pauzenberger L, Grieb A, Hexel M, et al. Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(2): 595-601.
22.	Qi Y, Yang X, Pan Z, et al. Value of antibiotic prophylaxis in routine knee arthroscopy: a retrospective study. Orthopade, 2018, 47(3): 246-253.
23.	Randelli P, Castagna A, Cabitza F, et al. Infectious and thromboembolic complications of arthroscopic shoulder surgery. J Shoulder Elbow Surg, 2010, 19(1): 97-101.
24.	Rose R, Ameerally A, Frankson M, et al. Knee arthroscopy: surgical site infections and the need for prophylactic antibiotics. Internet J Orthop Surg, 2007, 10: 2.
25.	Wieck JA, Jackson JK, O'Brien TJ, et al. Efficacy of prophylactic antibiotics in arthroscopic surgery. Orthopedics, 1997, 20(2): 133-134.
26.	Wyatt RWB, Maletis GB, Lyon LL, et al. Efficacy of prophylactic antibiotics in simple knee arthroscopy. Arthroscopy, 2017, 33(1): 157-162.
27.	Marrero LG, Nelman KR, Nottage WM. Long-term follow-up of arthroscopic rotator cuff repair. Arthroscopy, 2011, 27(7): 885-888.
28.	Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy, 2002, 18(2 Suppl 1): 88-95.
29.	Mirzayan R, Itamura JM, Vangsness CT, et al. Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg Am, 2000, 82(8): 1115-1121.
30.	Michelsen MI, Mejdahl S. Deep infection (purulent arthritis) following arthroscopic knee surgery in Denmark 1998-2000. Ugeskr Laeger, 2004, 166(19): 1763-1766.
31.	张孟希, 柴明珍, 邱福建. 某转型医院骨科I类切口手术预防性使用抗菌药物的调查与分析. 海军医学杂志, 2018, 39(5): 424-426, 458.
32.	Lai MC, Yeo W, Tan AHC. The incidence of infection in routine knee arthroscopy without the use of prophylactic antibiotics is low. Proceed Singap Health, 2019, 28(2): 110-114.
33.	Shehab N, Patel PR, Srinivasan A, et al. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis, 2008, 47(6): 735-743.
34.	Tamma PD, Avdic E, Li DX, et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med, 2017, 177(9): 1308-1315.
35.	胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 2020, 20(3): 233-243.
36.	Tang Q, Song P, Li J, et al. Control of antibiotic resistance in China must not be delayed: The current state of resistance and policy suggestions for the government, medical facilities, and patients. Biosci Trends, 2016, 10(1): 1-6.

1. Jain NB, Higgins LD, Losina E, et al. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskel Dis, 2014, 15: 4.
2. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am, 2011, 93(11): 994-1000.
3. De Luca A, Green W, Canobbio M, et al. Strategies to effectively prevent surgical site infections in Italian hospitals: economic benefits. Value Health, 2017, 20(9): A782.
4. D'Angelo GL, Ogilvie-Harris DJ. Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis. Arthroscopy, 1988, 4(1): 10-14.
5. 抗菌药物临床应用指导原则修订工作组. 抗菌药物临床应用指导原则: 2015 年版. 北京: 人民卫生出版社, 2015.
6. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt), 2013, 14(1): 73-156.
7. Anil U, Badri A, Pham H, et al. Perioperative antibiotic utilization by orthopedic surgeons in arthroscopic surgery a survey of practice patterns. Bull Hosp Jt Dis, 2020, 78(2): 97-100.
8. Marmor S, Farman T, Lortat-Jacob A. Joint infection after knee arthroscopy: medicolegal aspects. Orthop Traumatol Surg Res, 2009, 95(4): 278-283.
9. Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg, 2008, 16(5): 283-293.
10. Marks M, Bell LCK, Jones I, et al. Clinical and economic impact of implementing OVIVA criteria on patients with bone and joint infections in outpatient parenteral antimicrobial therapy. Clin Infect Dis, 2020, 71(1): 207-210.
11. Kurzweil PR. Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy, 2006, 22(4): 452-454.
12. Baraza N, Leith J. Are prophylactic intravenous antibiotics required in routine shoulder arthroscopic surgery? A systematic review of the literature. Joints, 2018, 6(1): 54-57.
13. Mader JT, Cierny G. The principles of the use of preventive antibiotics. Clin Orthop Relat Res, 1984, (190): 75-82.
14. Tarchini G, Liau KH, Solomkin JS. Antimicrobial stewardship in surgery: challenges and opportunities. Clin Infect Dis, 2017, 64(suppl_2): S112-S114.
15. Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control, 1999, 27(2): 97-132.
16. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
17. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1. 0), 2011. Available at: https://training.cochrane.org/handbook/archive/v5.1/.
18. Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy, 2007, 23(1): 4-6.
19. Hoel RJ, Mittelsteadt MJ, Samborski SA, et al. Preoperative antibiotics in wrist arthroscopy. J Hand Surg Am, 2018, 43(11): 987-991.
20. Naqvi GA, Jahangiri S, Malik SA, et al. Prophylactic antibiotics for elective knee arthroscopy: Do we really need it? Irish J Med Sci, 2011, 180: S101-S102.
21. Pauzenberger L, Grieb A, Hexel M, et al. Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surg Sports Traumatol Arthrosc, 2017, 25(2): 595-601.
22. Qi Y, Yang X, Pan Z, et al. Value of antibiotic prophylaxis in routine knee arthroscopy: a retrospective study. Orthopade, 2018, 47(3): 246-253.
23. Randelli P, Castagna A, Cabitza F, et al. Infectious and thromboembolic complications of arthroscopic shoulder surgery. J Shoulder Elbow Surg, 2010, 19(1): 97-101.
24. Rose R, Ameerally A, Frankson M, et al. Knee arthroscopy: surgical site infections and the need for prophylactic antibiotics. Internet J Orthop Surg, 2007, 10: 2.
25. Wieck JA, Jackson JK, O'Brien TJ, et al. Efficacy of prophylactic antibiotics in arthroscopic surgery. Orthopedics, 1997, 20(2): 133-134.
26. Wyatt RWB, Maletis GB, Lyon LL, et al. Efficacy of prophylactic antibiotics in simple knee arthroscopy. Arthroscopy, 2017, 33(1): 157-162.
27. Marrero LG, Nelman KR, Nottage WM. Long-term follow-up of arthroscopic rotator cuff repair. Arthroscopy, 2011, 27(7): 885-888.
28. Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy, 2002, 18(2 Suppl 1): 88-95.
29. Mirzayan R, Itamura JM, Vangsness CT, et al. Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg Am, 2000, 82(8): 1115-1121.
30. Michelsen MI, Mejdahl S. Deep infection (purulent arthritis) following arthroscopic knee surgery in Denmark 1998-2000. Ugeskr Laeger, 2004, 166(19): 1763-1766.
31. 张孟希, 柴明珍, 邱福建. 某转型医院骨科I类切口手术预防性使用抗菌药物的调查与分析. 海军医学杂志, 2018, 39(5): 424-426, 458.
32. Lai MC, Yeo W, Tan AHC. The incidence of infection in routine knee arthroscopy without the use of prophylactic antibiotics is low. Proceed Singap Health, 2019, 28(2): 110-114.
33. Shehab N, Patel PR, Srinivasan A, et al. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis, 2008, 47(6): 735-743.
34. Tamma PD, Avdic E, Li DX, et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med, 2017, 177(9): 1308-1315.
35. 胡付品, 郭燕, 朱德妹, 等. 2019 年 CHINET 三级医院细菌耐药监测. 中国感染与化疗杂志, 2020, 20(3): 233-243.
36. Tang Q, Song P, Li J, et al. Control of antibiotic resistance in China must not be delayed: The current state of resistance and policy suggestions for the government, medical facilities, and patients. Biosci Trends, 2016, 10(1): 1-6.

Chinese Journal of Evidence-Based Medicine

Efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy: a meta-analysis

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