Correlation between the period and dose of glucocorticoid injection and postoperative infection after shoulder arthroscopy

doi:10.3877/cma.j.issn.1674-1358.2020.02.007

Abstract

Abstract:

Objective

To investigate the effect of glucocorticoid injection period and dose on postoperative infection after shoulder arthroscopy, and to provide new ideas for prevention and treatment of complications after shoulder arthroscopy.

Methods

Total of 94 patients who were treated in Puning People’s Hospital and underwent shoulder arthroscopic surgery from February 2014 to March 2018 were selected, according to with or without postoperative infection, the patients were divided into infected group (21 cases) and uninfected group (73 cases), and the incidence of infection and distribution of pathogenic bacteria were analyzed, respectively. The correlation between age, gender, hospitalization days, operation time, glucocorticoid use and rate of postoperative infection were analyzed, respectively. The time and dose of glucocorticoid therapy were recorded. The influences of time and dose of glucocorticoid injection on infection after shoulder arthroscopy were predicted by ROC curve.

Results

There were 21 patients with infection after shoulder arthroscopy, and the infection rate was 22.3%, among which, 8 strains (38.0%) of Gram-negative bacteria, 12 strains (57.2%) of Gram-positive bacteria, and 1 strain (4.8%) of fungi were isolated. Compared with uninfected group, the age, hospitalization days, operation time, diabetes mellitus, antimicrobial use time, daily dose and time difference of glucocorticoid treatment were significantly different in the infected group (all P < 0.05). Multivariate Logistic regression analysis showed that operation time (OR = 1.238, P = 0.026), daily average dose of glucocorticoid (OR = 1.485, P = 0.019) and using time (OR = 0.968, P = 0.018) were all independent risk factors for postoperative infection. The area under ROC curve of glucocorticoid cumulative treatment time after shoulder arthroscopy was 0.805, 95% confidence interval (CI) was 0.685-0.924, and cut-off value was 5.16. The area under ROC curve of daily average dose of glucocorticoid after shoulder arthroscopy was 0.909, 95%CI was 0.830-0.988, and cut-off value was 12.67, all with significant differences (all P < 0.001).

Conclusions

Gram-positive bacteria were the main pathogen after shoulder arthroscopy. Long-term and high-dose glucocorticoid injection may increase the risk of infection after shoulder arthroscopy. Therefore, reasonable and efficient use of glucocorticoids after shoulder arthroscopy was important to avoid infection.

Key words: Shoulder arthroscopy, Glucocorticoid, Infection

Zhensheng Lu, Shouqiu Ye, Ting Yang, Xuli Huang. Correlation between the period and dose of glucocorticoid injection and postoperative infection after shoulder arthroscopy[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(02): 123-127.

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References 25

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病原菌		株数	构成比（%）
革兰阴性菌		8	38.0
?	鲍曼不动杆菌	2	9.5
?	大肠埃希菌	5	23.7
?	丙酸杆菌	1	4.8
革兰阳性菌		12	57.2
?	金黄色葡萄球菌	6	28.7
?	表皮葡萄球菌	4	19.0
?	溶血链球菌	2	9.5
真菌		1	4.8
?	白假丝酵母菌	1	4.8

病原菌		株数	构成比（%）
革兰阴性菌		8	38.0
?	鲍曼不动杆菌	2	9.5
?	大肠埃希菌	5	23.7
?	丙酸杆菌	1	4.8
革兰阳性菌		12	57.2
?	金黄色葡萄球菌	6	28.7
?	表皮葡萄球菌	4	19.0
?	溶血链球菌	2	9.5
真菌		1	4.8
?	白假丝酵母菌	1	4.8

影响因素		感染组（21例）	未感染组（73例）	χ²值	P值
性别[例（%）]		?	?	0.170	0.805
?	男	9（42.9）	35（47.0）	?	?
?	女	12（57.1）	38（53.0）	?	?
年龄分布[例（%）]		?	?	4.283	0.034
?	< 55岁	7（64.3）	43（48.5）	?	?
?	≥ 55岁	14（35.7）	30（51.5）	?	?
住院时间（±s，d）		17.35 ± 4.24	12.91 ± 6.28	18.357	0.001
手术时间（±s，min）		145.42 ± 23.61	105.95 ± 28.67	21.672	< 0.001
肩关节疾病种类[例（%）]		?	?	0.156	0.984
?	粘连性肩关节炎	5（35.7）	20（30.3）	?	?
?	钙化性冈上肌肌腱炎	3（21.4）	14（21.2）	?	?
?	肩关节滑膜炎	4（28.6）	20（30.3）	?	?
?	肩关节骨性关节炎	2（14.3）	12（18.2）	?	?
合并糖尿病[例（%）]		?	?	12.195	0.001
?	是	14（71.4）	18（31.8）	?	?
?	否	7（28.6）	55（68.2）	?	?
抗菌药物使用时间（±s，d）		13.26 ± 3.75	5.52 ± 3.03	28.648	< 0.001
糖皮质激素治疗		?	?	?	?
?	累积治疗时间（±s，d）	7.57 ± 1.52	3.67 ± 1.45	19.572	< 0.001
?	日均治疗剂量（mg/d)	19.08 ± 5.27	8.57 ± 3.23	17.579	< 0.001

影响因素		感染组（21例）	未感染组（73例）	χ²值	P值
性别[例（%）]		?	?	0.170	0.805
?	男	9（42.9）	35（47.0）	?	?
?	女	12（57.1）	38（53.0）	?	?
年龄分布[例（%）]		?	?	4.283	0.034
?	< 55岁	7（64.3）	43（48.5）	?	?
?	≥ 55岁	14（35.7）	30（51.5）	?	?
住院时间（±s，d）		17.35 ± 4.24	12.91 ± 6.28	18.357	0.001
手术时间（±s，min）		145.42 ± 23.61	105.95 ± 28.67	21.672	< 0.001
肩关节疾病种类[例（%）]		?	?	0.156	0.984
?	粘连性肩关节炎	5（35.7）	20（30.3）	?	?
?	钙化性冈上肌肌腱炎	3（21.4）	14（21.2）	?	?
?	肩关节滑膜炎	4（28.6）	20（30.3）	?	?
?	肩关节骨性关节炎	2（14.3）	12（18.2）	?	?
合并糖尿病[例（%）]		?	?	12.195	0.001
?	是	14（71.4）	18（31.8）	?	?
?	否	7（28.6）	55（68.2）	?	?
抗菌药物使用时间（±s，d）		13.26 ± 3.75	5.52 ± 3.03	28.648	< 0.001
糖皮质激素治疗		?	?	?	?
?	累积治疗时间（±s，d）	7.57 ± 1.52	3.67 ± 1.45	19.572	< 0.001
?	日均治疗剂量（mg/d)	19.08 ± 5.27	8.57 ± 3.23	17.579	< 0.001

影响因素	β值	标准误	Wald χ²值	P值	OR值	95%CI值
手术时间	0.648	1.096	7.348	0.026	1.238	1.116～2.368
糖皮质激素治疗时间	0.968	0.749	8.672	0.019	0.968	0.438～1.529
糖皮质激素治疗日均剂量	0.709	0.937	8.064	0.018	1.485	0.945～1.973

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