髋膝关节置换术后假体周围感染病原菌分布与耐药性变化趋势分析

Distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty

目的:研究髋、膝关节置换术后假体周围感染的病原菌分布和病原菌耐药性变化,为有效应对耐药菌制定防治策略。方法:收集2010年至2015年符合纳入标准的146例初次髋、膝关节置换术后假体周围感染病例相关资料,其中髋关节置换术后假体周围感染111例,膝关节置换术后假体周围感染35例。统计历年的培养阳性率、病原菌构成与耐药率,分析病原菌分布与耐药性的变化趋势。结果:146例中共检出病原菌108株,培养阳性率为73.97%。革兰阳性菌为主要病原菌,占55.48%,表皮葡萄球菌与金黄色葡萄球菌分别占25.34%及15.07%。革兰阴性菌占13.01%,包含阴沟肠杆菌、铜绿假单胞菌及大肠埃希菌等。分别有4例结核分枝杆菌感染和混合感染。历年的培养结果显示,革兰阳性菌的构成比有增加的趋势,波动在39.13%~76.47%。药敏结果显示病原菌对β-内酰胺类、喹诺酮类、克林霉素、庆大霉素有较高耐药性,且耐药率有不断增加的趋势,但对利福平、呋喃妥因、替加环素、利奈唑胺、万古霉素仍较敏感。结论:假体周围感染的病原菌以革兰阳性菌为主,所占比例有逐渐增加趋势。病原菌对多种抗菌药物有较高的耐药性,且耐药率仍不断增加。加强对病原菌分布及耐药性的监测,有助于掌握其变化趋势,并以此制定针对性的防治策略。

Objective:To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty,and to formulate prevention and treatment strategies for drug-resistant bacteria.Methods:The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected,including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty.The culture positive rate,pathogenic bacteria composition and drug resistance rate were counted over the years,and the change trend of pathogen distribution and drug resistance was analyzed.Results:One hundred and eight strains of pathogenic bacteria were detected in 146 cases,and the positive rate of culture was 73.97%.Gram positive bacteria accounted for 55.48%,Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34%and 15.07%respectively.Gram negative bacteria accounted for 13.01%,including Enterobacter cloacae,Pseudomonas aeruginosa and Escherichia coli.There were 4 cases of Mycobacterium tuberculosis infection and mixed infection.The results of culture over the years showed that the constituent ratio of Gram-positive bacteria had an increasing trend,fluctuating from 39.13%to 76.47%.The results of drug sensitivity showed that the pathogens were highly resistant toβ-lactams,quinolones,clindamycin and gentamicin,and the drug resistance rate was increasing,but it was still sensitive to rifampicin,nitrofurantoin,tigecycline,linezolid and vancomycin.Conclusion:Gram positive bacteria are the main pathogens of periprosthetic infection,and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics,and the resistance rate is still increasing.To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.