人工关节置换术后假体周围组织感染的病原菌分布及耐药性分析

Analysis of pathogen distribution and drug resistance of tissue infection around prosthesis after artificial joint replacement

目的研究分析人工关节置换术后假体周围组织感染的病原菌分布及其耐药情况。方法回顾性分析自2015-01-2017-12诊治的75例人工关节置换术后假体周围组织感染病例,取关节液进行普通细菌培养,同时抽取关节液注入BD血培养瓶培养,存在窦道者取窦道分泌物培养,翻修术中取至少4份不同部位的组织标本进行普通细菌培养。统计分析病原菌情况及主要病原菌药敏试验结果。结果 75例中有47例培养出细菌,阳性率62.7%。革兰氏阳性菌31例,革兰氏阴性菌12例,真菌3例,偶发分枝杆菌1例。革兰氏阳性菌对万古霉素、替考拉宁、利奈唑胺全部敏感,革兰氏阴性菌中未发现多重耐药菌株。4例大肠埃希菌对三代头孢、酶抑制剂组合制剂、氨基糖苷类、喹诺酮类等有较好的敏感性,碳青霉烯类100%敏感,未发现产超光谱β内酰胺酶菌株。结论人工关节置换术后假体周围组织感染的病原菌来源广泛,革兰氏阳性菌中以金黄色葡萄球菌为主,革兰氏阴性菌中以大肠埃希氏菌为主。万古霉素对革兰氏阳性菌保持100%敏感性,是关节翻修术抗生素骨水泥载药首选。革兰阴性感染菌对三代头孢菌素、酶抑制剂组合制剂、氨基糖苷类、喹诺酮类、碳青霉烯类保持较好的敏感性。

Objective To analyze the distribution and drug resistance of pathogens in tissues around artificial joint prosthesis after artificial joint replacement. Methods Retrospective analysis of 75 cases of prosthetic tissue infection after prosthetic replacement from Jan. 2015 to Dec. 2017 was performed, joint fluid was taken for common bacterial culture, and culture in BD blood culture bottle, if there was a sinus, the sinus secretion was taken for culture. At least 4 tissue specimens of different parts were taken during the revision for common bacterial culture. Statistical analysis of pathogens and drug susceptibility test results of major pathogens were conducted. Results Among the 75 cases, 47 cases were cultured with bacteria, and the positive rate was 62.7%. There were 31 Gram-positive bacteria, 12 Gram-negative bacteria, 3 fungi, and 1 case of Mycobacterium.Gram-positive bacteria were all sensitive to vancomycin, teicoplanin, and linezolid, and no multi-drug resistant strains were found in Gram-negative bacteria. Four cases of Escherichia coli had good sensitivity to third-generation cephalosporin, enzyme inhibitor combination preparation, aminoglycoside, quinolones, etc., carbapenems were 100% sensitive, and no hyperspectral beta-lactamase strains were found. Conclusion The pathogens of tissue infection around the prosthesis after artificial joint replacement have a wide range of sources. Gram-positive bacteria are mainly Staphylococcus aureus, and Gram-negative bacteria are mainly Escherichia coli. Vancomycin maintains 100% sensitivity to Gram-positive bacteria and is the first choice for antibiotic bone cement loading for joint revision surgery. Gram-negative infectious bacteria maintain good sensitivity to third-generation cephalosporins, enzyme inhibitor combination preparations, aminoglycosides, quinolones, and carbapenems.