摘要
目的分析人工髋膝关节置换术后假体周围感染(PJI)患者的微生物培养结果、药物敏感性实验结果及手术治疗方法。方法收集2014—2016年北京市9家医院收治的髋、膝关节置换术后诊断为PJI的318例患者资料,其中髋关节置换术后患者148例(148髋),膝关节置换术后患者170例(170膝),患者年龄(62.3±13.1)岁(范围:21~86岁),男性145例,女性173例,体重指数(25.6±3.8)kg/m 2(范围:15.6~38.1 kg/m2)。结果318例患者关节腔穿刺液和(或)关节腔内组织微生物培养结果示革兰阳性菌209例(65.7%),革兰阴性菌29例(9.1%),真菌10例(3.1%),非结核分枝杆菌3例(0.9%),培养阴性72例(22.6%),甲氧西林耐药菌69例(21.7%);抗菌药物的药物敏感性实验结果示青霉素、头孢呋辛、阿莫西林+棒酸总体耐药率较高,分别为79.9%、69.9%、68.1%;美罗培南、万古霉素、利奈唑胺耐药率均为0。髋、膝关节置换术后PJI患者的手术治疗方式中,二期翻修术分别占72.9%(108/148)和64.1%(109/170),一期翻修术占21.6%(32/148)和7.6%(13/170)、开放清创术占4.7%(7/148)和26.4%(45/170)。结论革兰阳性菌为髋、膝关节置换术后PJI的主要病原菌,需警惕耐药菌和罕见菌的产生,本组病例中二期翻修术仍是PJI的主要手术治疗方式。
Objective To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range: 15.6-38.1 kg/m2). Results In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively;meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9%(108/148) and 64.1%(109/170), respectively. One-stage revision surgery accounted for 21.6%(32/148) and 7.6%(13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4%(45/170). Conclusions Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.
作者
彭慧明
王龙超
陈继营
周一新
田华
林剑浩
郭万首
林源
曲铁兵
郭艾
曹永平
翁习生
Peng Huiming;Wang Longchao;Chen Jiying;Zhou Yixin;Tian Hua;Lin Jianhao;Guo Wanshou;Lin Yuan;Qu Tiebing;Guo Ai;Cao Yongping;Weng Xisheng(Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;Department of Orthopedics, Peking University First Hospital, Beijing 100034, China;Department of Orthopedics, Guangdong Provincial People′s Hospital, Guangzhou 510080, China;Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China;Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China;Department of Orthopedics, Peking University Third Hospital, Beijing 100083, China;Department of Orthopedics, Peking University People′s Hospital, Beijing 100044, China;Department of Orthopedics, Sino-Japanese Friendship Hospital, Beijing 100029, China;Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;Department of Orthopedics, China Rehabilitation Research Center Beijing Boai Hospital, Beijing 100068, China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2019年第8期596-600,共5页
Chinese Journal of Surgery
关键词
关节成形术
置换
髋
关节成形术
置换
膝
微生物
抗菌药物
感染
Arthroplasty, replacement, hip
Arthroplasty, replacement, knee
Bacteria
Antibiotics
Infection