单次与多次抗生素方案对关节置换术护理负荷及医疗成本的影响

doi:10.3969/j.issn.1006-5725.2026.02.017

Abstract

Abstract:

Objective To evaluate the effects of different antibiotic regimens applied in orthopedic joint surgery through multi-departmental collaboration on optimizing nursing human resource allocation and reducing medical consumables expenditure， and to verify whether its safety in preventing infection is non-inferior to the traditional regimen. Methods A retrospective cohort study was conducted. A total of 1 948 patients from the Department of Knee Surgery between May 10， 2021， and May 22， 2024， were selected. A subgroup analysis of inflammatory markers was performed on 303 of these patients （44 hip joints， 259 knee joints）. Patients were divided into a single-dose group （972 cases） and a multiple-dose group （976 cases） based on the antibiotic regimen. The single-dose group received only one postoperative dose of antibiotics， while the multiple-dose group received multiple postoperative doses. The primary outcome was the relationship between the number of antibiotic packages used and the incidence of prosthetic joint infection （PJI） within 12 months postoperatively. Secondary outcomes included inflammatory markers： white blood cell count （WBC）， neutrophil count， C-reactive protein （CRP）， and erythrocyte sedimentation rate （ESR）； cost-effectiveness indicators： antibiotic infusion cost （as a single hospitalization expense）； and nursing workload： infusion distance plus needle removal distance. Statistical analyses included logistic regression and the Mann-Whitney U test. Results The overall incidence of prosthetic joint infection （PJI） at 12 months postoperatively was low. The PJI rates in the single-dose and multiple-dose groups were 1.5% （15/972） and 1.3% （13/976）， respectively， with no statistically significant difference （OR = 1.039， 95%CI： 0.927 ~ 1.164， P = 0.512）. Subgroup analysis results： For hip arthroplasty patients using cefuroxime sodium， inflammatory markers （WBC， neutrophils， CRP， ESR） showed statistically significant differences at various time points within each group （P < 0.05）， but no statistically significant intergroup differences were observed （P > 0.05）. For knee arthroplasty patients using cefazolin sodium， inflammatory markers （WBC， neutrophils， CRP， ESR） showed statistically significant differences at various time points within each group （P < 0.05）. The intergroup difference for CRP was not comparable （P < 0.05）， while no statistically significant intergroup differences were found for the remaining markers （P > 0.05）. For knee arthroplasty patients using cefuroxime sodium， inflammatory markers （WBC， neutrophils， CRP， ESR） showed statistically significant differences at various time points within each group （P < 0.05）. The intergroup difference for ESR was not comparable （P < 0.05）， while no statistically significant intergroup differences were observed for the remaining markers （P > 0.05）. Cost-effectiveness analysis： The median antibiotic cost in the single-dose group was significantly lower than that in the multiple-dose group （74.13 RMB vs. 164.16 RMB， Z = -39.090， P < 0.001）. The nursing workload （infusion distance + needle removal distance） was reduced by a median of 67.1% （298.4 meters vs. 907.8 meters， Z = -37.536， P < 0.001）. Conclusions The single-dose antibiotic regimen is comparable to the multiple-dose regimen in preventing infections， while significantly reducing medical costs （by 55%） and nursing workload （by 67%）. Its clinical adoption is recommended. This study is a single-center retrospective investigation， and future multi-center prospective studies are warranted for further validation.

Key words: antibiotic protocols, arthroplasty, nursing burden, medical costs

CLC Number:

R473.6

Yanhong JIANG,Yiyin XU,Ruotong LIAO,Lijun WEI,Xuewei CAO,Minqing LI,Jinhui LIAO,Jiajie HUANG,Xingli CHEN. An empirical study on the impact of single-dose and multiple-dose antibiotic regimens on nursing workload and medical costs in total joint arthroplasty： A nursing-led systematic review[J]. The Journal of Practical Medicine, 2026, 42(2): 311-319.

Figures/Tables 11

Tab.1

Fig.1

Fig.2

Fig.3

Fig.4

Tab.2

Comparison of baseline characteristics between the two groups in cefuroxime sodium subgroup after primary hip arthroplasty"

因素	多次组（n = 24）	单次组（n = 20）	t/χ²/Z值	P值
年龄/岁	64.04 ± 14.669	56.65 ± 14.280	1.684	0.100
性别（女）/例	17	11	1.182	0.277
胸片肺部炎症（阴性）/例	22	16	1.261	0.264
尿WBC阳性/例	5	3	0.178	0.673
合并患糖尿病/例	20	16	0.081	0.775
术前Hb/（g/L）	128.96 ± 10.768	133.30 ± 14.729	-1.128	0.266
术后3 h Hb	108.88 ± 11.987	114.60 ± 17.893	-1.265	0.213
术后第1天Hb	106.04 ± 10.411	110.65 ± 16.259	-1.094	0.282
出院前Hb	99.006 ± 14.197	104.790 ± 16.471	-1.251	0.218
入院白蛋白/（g/L）	42.892 ± 4.538	43.175 ± 5.157	0.194	0.847
术后第1天白蛋白/（g/L）	35.514 ± 4.505	35.535 ± 4.634	-0.015	0.988
术后第3天白蛋白/（g/L）	36.181 ± 3.019	36.749 ± 3.083	-0.616	0.541
术前WBC［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	6.46（5.47，7.70）	6.29（5.29， 7.83）	-0.165	0.869
术前中性粒细胞计数［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	4.44（3.50， 5.28）	3.82（3.16，4.98）	-0.943	0.346
术前CRP［M（P₂₅，P₇₅）］/（mg/L）	5.31（1.91， 13.37）	6.99（1.71， 10.00）	-0.472	0.637
术前ESR［M（P₂₅，P₇₅）］	37（25.25，51.75）	34.5（26.25， 54.25）	-0.177	0.860

Tab.2

Fig.5

Tab.3

Comparison of general data between the two groups in cefazolin sodium subgroup after primary knee arthroplasty"

因素	多次组（n = 68）	单次组（n = 62）	t/χ²/Z值	P值
年龄/岁	67.49±7.735	68.26±6.191	-0.625	0.533
性别（女）/例	55	55	1.526	0.217
胸片肺部炎症（阴性）/例	61	36	17.142	0.001
尿WBC阳性/例	16	22	2.240	0.134
合并患糖尿病/例	52	42	1.234	0.267
术前Hb/（g/L）	130.19±12.096	129.1±12.010	0.487	0.627
术后3 h Hb	121.57±13.931	118.4±11.315	1.380	0.170
术后第1天Hb	124.24±12.741	120.3±12.187	1.793	0.075
出院前Hb	114.29±11.101	112.2±11.470	1.044	0.299
入院白蛋白/（g/L）	44.274±2.898	44.055±3.257	0.405	0.686
术后第1天白蛋白/（g/L）	39.831±3.000	39.504±3.074	0.615	0.540
术后第3天白蛋白/（g/L）	38.469±2.584	38.537±2.961	-0.139	0.890
术前WBC［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	6.47（5.63， 7.49）	7.00（5.66， 8.29）	-1.412	0.158
术前中性粒细胞计数［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	4.10（3.28， 4.96）	4.47（3.41， 5.74）	-1.305	0.192
术前CRP［M（P₂₅，P₇₅）］/（mg/L）	2.35（0.84， 6.08）	6.60（1.81， 10.07）	-3558	0.001
术前ESR［M（P₂₅，P₇₅）］	31（22.25， 48.00）	32.5（21.00， 39.50）	0.718	0.473

Tab.3

Fig.6

Tab.4

Comparison of baseline characteristics betweenthe two groups in cefuroxime sodium subgroup after primary knee arthroplasty"

因素	多次组（n = 61）	单次组（n = 68）	t/χ²/Z值	P值
年龄/岁	67.70 ± 10.918	69.59 ± 6.447	-1.207	0.230
性别（女）/例	54	62	0.250	0.617
胸片肺部炎症（阴性）/例	57	50	9.014	0.003
尿WBC阳性/例	20	20	0.171	0.679
合并患糖尿病/例	39	38	0.866	0.352
术前Hb/（g/L）	131.48 ± 11.088	129.10 ± 12.370	1.142	0.256
术后3 h Hb	119.85 ± 11.347	119.68 ± 11.932	0.086	0.932
术后第1天Hb	121.80 ± 12.243	121.26 ± 12.882	0.243	0.809
出院前Hb	114.827 ± 11.576	114.526 ± 11.986	0.145	0.885
入院白蛋白/（g/L）	44.474 ± 5.040	44.382 ± 3.083	0.126	0.900
术后第1天白蛋白/（g/L）	39.441 ± 4.176	39.708 ± 2.891	-0.426	0.671
术后第3天白蛋白/（g/L）	38.749 ± 3.309	38.490 ± 3.091	0.478	0.633
术前WBC［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	6.37（5.36， 7.70）	6.38（5.60，7.84）	-0.365	0.715
术前中性粒细胞计数［M（P₂₅，P₇₅）］/（ $×$ 10⁹·L^-1）	4.38（3.56， 5.20）	4.07（3.43， 5.12）	-1.076	0.282
术前CRP［M（P₂₅，P₇₅）］/（mg/L）	3.61（1.29， 6.16）	5.75（1.75， 10.00）	-1.798	0.072
术前ESR［M（P₂₅，P₇₅）］	40.00（22.00，64.00）	27.00（20.00，38.00）	-2.938	0.003

Tab.4

Fig.7

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项目	单次组（n = 972）	多次组（n = 976）	t/χ²值	P值
年龄/岁	67.50 ± 9.551	67.97 ± 9.104	-1.125	0.261
住院时间/d	7.33 ± 3.021	7.22 ± 2.813	0.800	0.424
BMI/（kg/m²）	25.655 ± 3.734	25.437 ± 3.676	1.300	0.194
性别/例			1.182	0.277
女	748	771
男	224	205
糖尿病史/例			0.173	0.678
合并	836	833
未合并	136	14
吸烟史/例			0.464	0.486
有	24	29
无	948	947
出院血白蛋白计量/例			0.308	0.579
> 35 g/L	72	66
< 35 g/L	900	910

An empirical study on the impact of single-dose and multiple-dose antibiotic regimens on nursing workload and medical costs in total joint arthroplasty： A nursing-led systematic review

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