人工关节假体周围感染的微生物学分析

Microbiological analysis in periprosthetic joint infection

目的探讨人工关节假体周围感染(PJI)细菌学的种类,为临床诊断和治疗提供依据。方法回顾性分析2011年6月至2015年12月北京积水潭医院收治的89例人工关节PJI患者的住院及门诊就诊记录资料。男29例,女60例,年龄(51.6±14.1)岁。其中,髋关节PJI 43例,膝关节PJI 46例。通过调查细菌检出结果,分析引起PJI的细菌种类及比例。结果共89例患者因人工关节PJI接受了翻修手术,67例患者检出细菌阳性结果 74份。其中,革兰阳性菌63份(85.1%),革兰阴性菌8份(10.8%),真菌3份(4.1%)。在革兰阳性菌中,葡萄球菌共52份,而耐甲氧西林的葡萄球菌共检出29份,占全部葡萄球菌的55.8%。结论耐甲氧西林葡萄球菌已成为引起PJI的主要细菌,粪肠球菌、革兰阴性菌以及真菌也会引起PJI。因此,在诊治过程中应规范采集并送检微生物学标本,尽可能地提高细菌检出率,明确病原学诊断和抗菌药的使用依据。

Objective To investigate the periprosthetic joint infection （ PJI） types of bacteriology provide basis for diagnosis and treatment of PJI. Methods From June 2011 to December 2015, the data of inpatient and outpatient records of 89 patients with PJI in Beijing Jishuitan Hospital were analyzed retrospectively. There were 29 males and 60 females, aged （51. 6 ± 14. 1） years. Among them, there were 43 cases of infection around the hip joint prosthesis and 46 cases of periprosthetic infection of the knee joint. Collecting the microbio-logy results of PJI, calculating the proportion of different types of microbe in PJI. Results There were 89 PJI patients underwent revision surgery during the study period. Sixty-seven patients had 74 units of positive cul-ture, including 63 units Gram-positive bacteria （85. 1% ） , 8 units Gram-negative bacteria （10. 8% ） and 3 units fungi （4.1% ）. Of aQ the Gram-positive bacteria, staphylococcus counted for 52 units while 29 of them were Methicillin-resistant, occupy 55.8%. Conclusion Methicillin-resistant staphylococcus is the major bac-teria of PJI. Enterococcus faecalis, gram negative bacteria and fungi can also cause periprosthetic infection. Therefore we should regulate the collection and submission of microbiology specimen in the diagnosis and treat-ment process, as far as possible to improve the detection rate of bacteria, clear etiology diagnosis and basis for antimicrobial drug use.