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感控热点丨旨在减少全髋膝关节置换患者感染的新指南发布！ 检索：刘金淑 河南省濮阳市油田总医院
翻译：孔晓明 溧阳市人民医院 审核：刘金淑河南省濮阳市油田总医院 陈志锦 广东省东莞市厚街医院 根据美国风湿病学会（ACR）和美国髋膝关节外科医师协会（AAHKS）发布的新指南，通过仔细管理围手术期的抗风湿药物，可以减少全髋关节和膝关节置换引起的关节感染的风险。该指南代表着风湿病学家和矫形外科医师首次携手制定规范。 假体周围关节感染仍然是髋膝关节置换失败的最常见原因之一，因为假体周围的关节感染与髋膝关节置换频繁失败甚至死亡率有关，因此，这两个学科都认可的围手术期管理建议是迫切需要的，以便使关节炎患者获得更好的疗效。 该指南包括关于哪些情况继续、暂停及重新开始使用药物治疗炎性风湿病，例如类风湿性关节炎、脊柱关节炎和系统性红斑狼疮，并提出了八条糖皮质激素最佳围术期剂量的建议。 降低感染风险的主要建议包括： · 在炎性关节炎患者手术前停用生物治疗。 · 在类风湿性关节炎、脊柱关节炎和青少年特发性关节炎患者手术前，至少禁用福卡西汀7天。 · 在所有系统性红斑狼疮患者进行关节置换手术前，应暂停利妥昔单抗和贝利木单抗。 除风湿病和骨科专家外，还组建了一个患者小组，以确保指南充分代表患者的关注和偏好。 患者小组有一个非常明确的信息，如果可以减少感染和发生其他并发症的可能性，他们愿意治疗炎性关节炎。患者小组还指出，这种偏好在狼疮患者中可能有所不同，因为这可能意味着存在器官的炎症，而这比继续使用药物导致的感染带来的健康风险更大。 ACR指南使用的是基于GRADE评估体系的系统评价。该方法为判断现有文献的质量提供了严格的标准，并能突出每个建议的优势。由于部分地区的数据有限，许多建议的质量仅为低至中等。 该指南附有详细描述患者对围手术期管理见解的文章，并已在医学杂志《关节炎护理与研究》上发表，这本杂志是ACR和美国风湿病卫生专业人员协会(ARHP)（ACR所属单位）的一家同行评议型期刋。该指南和患者小组文件也可在ACR网站上找到。 资料来源：美国风湿病学会 New Guideline Aims to Reduce Infections in Total Hip andKnee Replacement Patients
According to a new guideline released by the AmericanCollege of Rheumatology (ACR) and American Association of Hip and Knee Surgeons(AAHKS), the risk of joint infection resulting from total hip and kneereplacements can be reduced with careful management of anti-rheumaticmedications during the perioperative process. The guideline represents thefirst time rheumatologists and orthopedic surgeons have collaborated to developrecommendations. “Periprosthetic joint infection remains one of the most common reasonsfor failure of hip and knee replacement,” said Bryan D.Springer, MD, an orthopedic surgeon at the OrthoCarolina Hip and Knee Center inCharlotte, N.C., and AAHKS Education Council Chair, who served as aco-principal investigator for the guideline project. “Becauseperiprosthetic joint infections are associated with such high morbidity andmortality, we felt there was a dire need for perioperative managementrecommendations that could be subscribed to by both disciplines in order toprovide arthritis patients with better outcomes.” The guideline includes eight recommendations regardingwhen to continue, withhold and re-start medications commonly used to treatinflammatory rheumatic diseases (e.g., rheumatoid arthritis, spondyloarthritisand systemic lupus erythematosus), as well as the optimal perioperative dosingof glucocorticoids. Key recommendations for reducing the risk of infectioninclude:
•Discontinuing biologictherapy prior to surgery in patients with inflammatory arthritis.
•Withholding tofacitinib for at least seven days priorto surgery in rheumatoid arthritis, spondyloarthritis and juvenile idiopathicarthritis patients.
•Withholding rituximab and belimumab prior to surgeryin all systemic lupus erythematosus patients undergoing arthroplasty. In addition to rheumatology and orthopedic experts, apatient panel was incorporated to ensure the guidelines adequately representedpatients’ concerns andpreferences. “There was a very clear message from the patient panel that they werewilling to deal with flares if it meant reducing their likelihood forinfections and other complications,” said Susan M.Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York,who also served as a co-principal investigator. “Thepanel also noted that this preference could differ in lupus patients where aflare could mean inflammation of the organs, which poses a greater risk totheir health than getting an infection from continuing their medications.” ACR guidelines are developed using the Grading ofRecommendations Assessment, Development and Evaluation (GRADE) methodology,which sets forth rigorous standards for judging the quality of the availableliterature and assigns strengths to the recommendations. Due to limited data insome areas, many of the recommendations were low to moderate in strength. Both the guideline and a separate paper detailing patientinsights on perioperative management have been published in Arthritis Care& Research, a peer-reviewed medical journal by the ACR and the Associationof Rheumatology Health Professionals (a division of the ACR). The guideline andpatient panel paper are also available on the ACR website. Source: American College of Rheumatology 图文编辑：小小牧童
审稿：孙庆芬赵静
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发表于 2017-7-12 08:39
