假体周围感染102例病原菌分布、耐药及临床特征的差异分析

Distribution,drug resistance,and clinical characteristics of pathogenic bacteria in 102 cases of periprosthetic joint infection

背景:人工关节置换后的严重并发症假体周围感染一直是临床上棘手的问题,目前对其感染病原菌的特征研究不够充分,需要更多研究以助于临床诊疗。目的:探究人工关节置换后假体周围感染的病原菌分布及耐药情况,比较不同病原菌培养结果病例之间的特征差异。方法:回顾性分析2013年9月至2020年9月于郑州大学第一附属医院骨科就诊的102例假体周围感染患者的资料,统计病原菌培养结果、耐药情况等诊疗信息,以病原菌培养结果分为革兰阳性菌、革兰阴性菌、真菌及培养阴性4组,比较4组在一般情况、临床特征、手术方式及感染控制等方面的差异。结果与结论:①102例假体周围感染患者中66例患者病原菌培养阳性,共检出71株病原菌。革兰阳性菌占比57.8%,以表皮葡萄球菌(21.1%)和金黄色葡萄球菌(15.5%)最常见;革兰阴性菌占比29.6%,以大肠埃希菌(12.7%)最常见;真菌占比12.7%,以近平滑念珠菌(5.6%)最常见。②革兰阳性菌对青霉素G、苯唑西林、克林霉素及红霉素具有较高的耐药率,对万古霉素、替加环素及利奈唑胺的耐药率为0%;革兰阴性菌对喹诺酮类、庆大霉素、氨苄西林、头孢唑啉等抗生素具有较高的耐药率;未发现耐药真菌。③在性别、年龄、基础疾病、手术部位、感染类型、窦道、手术方式选择及感染控制率方面,4组间比较差异无显著性意义(P>0.05);早期感染中,培养阴性组C-反应蛋白水平低于革兰阳性菌组(P<0.05),血沉及白细胞计数低于革兰阴性菌组(P<0.05);髋关节假体周围感染组白细胞、C-反应蛋白、血沉水平高于膝关节假体周围感染组(P<0.05)。④结果提示引起假体周围感染的主要病原菌依然是革兰阳性菌,其中葡萄球菌占比最多,近平滑念珠菌感染增多值得重视;多种病原菌对一些常规抗生素具有较高耐药率,应根据药敏结果及疗效及时调整抗生素的使用。

BACKGROUND:Periprosthetic joint infection,a serious complication after artificial joint arthroplasty,has always been a thorny problem in clinical practice.At present,the research on the characteristics of the pathogenic bacteria is insufficient,and more research is needed to help clinical diagnosis and treatment.OBJECTIVE:To explore the distribution and drug resistance of pathogens in periprosthetic joint infection after knee and hip arthroplasties,and to compare the characteristics of different pathogen culture results.METHODS:A retrospective single-center research was used to study the data of 102 cases of periprosthetic joint infection in the Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from September 2013 to September 2020.Pathogen culture results,drug resistance,and other diagnosis and treatment information were collected.According to the results of pathogen culture,the patients were divided into four groups:gram-positive bacteria,gram-negative bacteria,fungi,and negative culture.The differences in general condition,clinical features,operation methods,and infection control were compared among the four groups.RESULTS AND CONCLUSION:(1)Totally 66 of 102 patients with periprosthetic joint infection were cultured positive for pathogenic bacteria,and 71 strains of pathogenic bacteria were detected.Gram-positive bacteria accounted for 57.8%.Staphylococcus epidermidis(21.1%)and Staphylococcus aureus(15.5%)were the most common.Gram-negative bacteria accounted for 29.6%and Escherichia coli(12.7%)was the most common.Fungi accounted for 12.7%,with Candida parapsilosis(5.6%)being the most common.(2)Gram-positive bacteria had high resistance rates to penicillin G,oxacillin,clindamycin,and erythromycin,and 0%to vancomycin,tigecycline,and linezolid.Gram-negative bacteria had a high resistance rate to antibiotics such as quinolones,gentamicin,ampicillin,and cefazolin;no drug-resistant fungi had been found.(3)There was no significant difference in sex,age,basic disease,operation site,infection type,sinus,operation mode,and infection control rate among the four groups(P>0.05).In early infection,the C reactive protein in culture negative group was lower than that in gram-positive bacteria group(P<0.05),and red serum sedimentation rate and white blood cell count in culture negative group were significantly lower than those in gram-negative bacteria group(P<0.05).Leukocyte,C-reactive protein,and erythrocyte sedimentation rate of hip periprosthetic infection were higher than those of knee periprosthetic infection(P<0.05).(4)It is concluded that the main pathogen causing periprosthetic joint infection is still gram-positive bacteria,of which Staphylococcus accounts for the largest proportion.The increase of Candida parapsilosis infection is worthy of attention.Multiple pathogenic bacteria have a high drug resistance rate to some conventional antibiotics,so the use of antibiotics should be adjusted in time according to the results of drug susceptibility and efficacy.