骨关节置换术后假体周围感染的病原菌特征及影响因素分析  

Etiological characteristics and influencing factors for postoperative periprosthetic joint infection in arthroplasty patients

作　　者：周一逸[1] 刘仪[1] 袁鹏[2] 冯德宏[1] 杨正杰[3] ZHOU Yi-yi;LIU Yi;YUAN Peng;FENG De-hong;YANG Zheng-jie(Wuxi People's Hospital,Wuxi,Jiangsu 214000,China)

机构地区：[1]无锡市人民医院骨科,江苏无锡214000 [2]无锡市人民医院康复科,江苏无锡214000 [3]无锡市第二人民医院骨科,江苏无锡214000

出　　处：《中华医院感染学杂志》2019年第14期2189-2193,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81073139)

摘　　要：目的分析骨关节置换术后假体周围感染(PJI)的病原菌特征,探讨PJI发生的影响因素,为未来PJI的防治提供参考。方法回顾分析医院2012年3月-2018年3月全髋膝关节置换术后1年内发生PJI的50例患者临床资料,将其作为病例组,将置换术后1年内未发生PJI 50例患者作为对照组,仔细阅览两组临床资料,记录其一般情况,分析病例组病原菌特征,找出可能导致PJI发生的影响因素。结果病例组细菌检出38例,多为单一感染;共检出细菌43株,以革兰阳性菌检出率最高;检出的43株病原菌自2012年3月-2018年3月六年,检出情况未见规律变化趋势,但有新增真菌感染趋势;经Logistic回归分析发现,高龄、髋膝手术史、贫血、血清蛋白低表达、糖尿病、类风湿关节炎、手术用时长、引流时间长、异体输血均可能是PJI影响因素(P<0.05)。结论骨关节置换术后PJI多因革兰阳性与革兰阴性菌引起,既往有膝髋部手术史、围术期接受异体输血、血清蛋白低表达可能是感染的影响因素,这类患者应引起临床重视。OBJECTIVE To investigate the etiological characteristics of postoperative periprosthetic joint infection(PJI) in arthroplasty patients and explore the influencing factor for PJI so as to provide guidance for prevention and treatment of PJI. METHODS Totally 50 patients who received total hip or knee arthroplasty from Mar 2012 to Mar 2018 and had PJI within 1 year after the surgery were assigned as the case group, and 50 patients who did not have PJI within 1 year after the surgery were set as the control group. The clinical data of the two groups of patients were reviewed, the baseline data were recorded, the etiological characteristics were analyzed, and the influencing factors for PJI were observed. RESULTS Totally 38 patients were detected with bacteria in the case group, most of whom had single infection;totally 43 strains of pathogens were isolated, the isolation rate of gram-positive bacteria was the highest. The isolation rates of the 43 strains of pathogens did not show regular change, however, the incidence of fungal infection showed an upward trend. Logistic regression analysis indicated that the influencing factors for PJI included the advanced age, history of hip and knee surgery, anemia, low expression of serum protein, diabetes mellitus, rheumatoid arthritis, long operation duration, long time of drainage and allogeneic blood transfusion(P<0.05). CONCLUSION The gram-positive bacteria and gram-negative bacteria are dominant among the pathogens causing postoperative PJI in the arthroplasty patients. The history of hip and knee surgery, perioperative allogeneic blood transfusion and low expression of serum protein are the influencing factors for the infection, which should be attached great importance to.

关 键 词：骨关节置换术 假体周围感染 病原菌特征 耐药 影响因素 

分 类 号：R687.4[医药卫生—骨科学]