假体周围感染翻修术前预防性应用抗生素对术中标本培养阳性率的影响研究

Effect of antibiotic prophylaxis before revision for periprosthetic joint infection on positive rate of intraoperative specimen culture

目的探讨假体周围感染(PJI)翻修术前预防性使用一剂敏感抗生素是否影响术中标本的培养阳性率。方法此前瞻性研究招募2017年7月1日至2019年2月1日福建医科大学附属第一医院骨科因PJI需行翻修手术的患者。所有患者术前停用抗生素2周后通过抽取关节液,经培养已明确病源菌及药敏结果,且术中取出部分/全部假体。按照入院顺序编号,使用随机数字表法将患者分为两组(A组和B组):A组在翻修手术切皮前30~60 min使用一剂敏感抗生素后再取标本,B组在所有标本取材后使用一剂敏感抗生素。术中取关节液、组织、组织研磨液(TGF)及超声假体裂解液(UPL)进行需氧及厌氧培养。根据术中至少有1项标本微生物培养阳性标准,分析及比较两组术前及术中培养结果。结果本研究共纳入32例术前关节液培养阳性的PJI患者,其中A组16例,B组16例。最常见的感染细菌为葡萄球菌(59.3%,19/32)。两组患者年龄、性别、手术方式、Tsukayama分型、假体移除及术前红细胞沉降率(ESR)、C反应蛋白(CRP)、关节滑液白细胞计数(SF-WBC)、关节滑液中性粒细胞(PMN)百分比差异均无统计学意义(P>0.05)。A组术中关节液、组织、TGF及UPL培养阳性率分别为81.3%(13/16)、62.5%(10/16)、93.8%(15/16)和93.8%(15/16),B组术中关节液、组织、TGF及UPL培养阳性率分别为87.5%(14/16)、68.8%(11/16)、93.8%(15/16)和100.0%(16/16),以上项目两组间比较差异均无统计学意义(P>0.05)。TGF与UPL培养阳性率在两组中比较差异均无统计学意义(P>0.05),但均明显高于各自组内组织培养阳性率,差异均有统计学意义(P<0.05)。结论①PJI翻修术前预防性使用抗生素不会影响术中标本培养阳性率,在PJI感染翻修手术前无需推迟使用预防性抗生素;②TGF培养阳性率与UPL培养阳性率无显著差异,但明显高于传统组织培养阳性率,对于无法进行超声裂解的机构可通过组织研磨的方法提高培养阳性率。

Objective To investigate whether the prophylactic use of a dose of sensitive antibiotics before revision for periprosthetic joint infection(PJI)may affect the positive rate of intraoperative specimen culture.Methods This prospective study recruited the patients who underwent revision due to PJI from July 1,2017 to February 1,2019 at Department of Orthopaedics,The First Affiliated Hospital to Fujian Medical University.After use of antibiotics was stopped in all patients for 2 weeks before operation,synovial fluid was extracted for culture to confirm pathogenic bacteria and drug sensitivity and some/all of the prostheses were removed during operation.According to their sequence number of admission,the patients were randomly divided into group A and group B.Samples were taken in group A after a dose of sensitive antibiotics was administered 30 to 60 minutes before revision while a dose of sensitive antibiotics was given in group B after all samples were taken.Intra-operatively,synovial fluid,tissue grinding fluid(TGF)and ultrasonic prosthesis lysate(UPL)were taken for aerobic and anaerobic culture.According to whether there was a positive culture of at least one microbiological specimen,the preoperative and intraoperative culture results were analyzed and compared between the 2 groups.Results A total of 32 PJI patients were included in this study due to positive culture of synovial fluid before operation,with 16 cases in group A and 16 in group B.The most common infection bacteria were staphylococci(59.3%,19/32).There was no significant difference in age,gender,mode of operation,Tsukayama classification,prosthesis removal,preoperative ESR,CRP,synovial fluid white blood cell count(SF-WBC)or polymorphonuclear cell percentage(PMN)between the 2 groups.The positive rates of synovial fluid,tissue,TGF and UPL were 81.3%(13/16),62.5%(10/16),93.8%(15/16)and 93.8%(15/16)for group A,and 87.5%(14/16),68.8%(11/16),93.8%(15/16)and 100.0%(16/16)for group B,showing insignificant differences between the 2 groups(P>0.05).The positive rates of TGF and UPL culture showed no significant difference between them in group A or in group B(P>0.05),but they were significantly higher than those of traditional tissue culture(P<0.05).Conclusions As prophylactic use of antibiotics before PJI revision may not affect the positive rate of intraoperative specimen culture,it is not necessary to postpone use of prophylactic antibiotics before PJI revision.Furthermore,as positive rates of TGF and UPL culture are similar but significantly higher than those of traditional tissue culture,tissue grinding can be used to improve the positive rate of tissue culture.