关节置换术后假体周围感染病原菌分布特点及治疗  

Distribution characteristics of pathogens and treatment of peri-prosthetic joint infection after artificial joint replacement

作　　者：闫开成 王昆[2] 胡锦桃 张卓辉 刘浩[3] 蔡芸[1] YAN Kai-cheng;WANG Kun;HU Jin-tao;ZHANG Zhuo-hui;LIU Hao;CAI Yun(Center of Medicine Clinical Research,Department of Pharmacy,Medical Supplies Center,Medical Supplies Center,Chinese PLA General Hospital,Beijing 100853,China;Service Guarantee Center,Medical Supplies Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Pharmacy, Medical Supplies Center, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院医疗保障中心药剂科药物临床研究室,北京100853 [2]解放军总医院服务保障中心,北京100853 [3]解放军总医院医疗保障中心药剂科,北京100853

出　　处：《中国感染控制杂志》2022年第6期546-553,共8页Chinese Journal of Infection Control

基　　金：国家自然科学基金(81770004、82073894);解放军总医院杰出青年科学家培养项目(2020-JQPY-004);新药验证基金(4246Z512)。

摘　　要：目的分析关节置换术后假体周围感染(PJI)病原菌分布特点、耐药情况及治疗,为临床合理选择抗菌药物提供依据。方法回顾性收集2019年1月—2021年11月某院收治的关节PJI患者临床资料,统计分析PJI病原菌分布、药敏试验结果以及患者抗菌药物使用情况。结果研究共纳入96例PJI患者,分离获得112株病原菌,革兰阳性菌株占80.36%,以葡萄球菌属细菌为主。药敏试验结果显示,表皮葡萄球菌对青霉素、苯唑西林耐药率分别为96.30%、81.48%,大肠埃希菌对庆大霉素、复方磺胺甲口恶唑、氨苄西林耐药率均为100%。PJI患者住院期间抗菌药物使用主要以联合用药为主,其中万古霉素联合美罗培南占26.04%;骨水泥中人工添加抗生素也以万古霉素和美罗培南为主。结论关节置换术后PJI主要病原菌为表皮葡萄球菌,其对青霉素、苯唑西林等普遍耐药,抗感染治疗以万古霉素联合美罗培南为主。Objective To analyze the distribution characteristics of pathogens,antimicrobial resistance and treatment of peri-prosthetic joint infection(PJI)after artificial joint replacement,and provide basis for clinical rational choice of antimicrobial agents.Methods Clinical data of patients with PJI and admitted to a hospital from January 2019 to November 2021 were collected retrospectively,distribution characteristics of pathogens,antimicrobial susceptibility testing results and antimicrobial use of patients were statistically analyzed.Results A total of 96 patients with PJI were included in the study,112 strains of pathogenic bacteria were isolated,80.36%of which were Gram-positive strains,mainly Staphylococcus spp..Antimicrobial susceptibility testing results showed that resistance rate of Staphylococcus epidermidis to penicillin and oxacillin were 96.30%and 81.48%respectively,resistance rates of Escherichia coli to gentamicin,compound sulfamethoxazole and ampicillin were all 100%.Antimicrobial use in PJI patients during hospitalization period was mainly combination,vancomycin combined with meropenem accounted for 26.04%;vancomycin and meropenem were also the main antimicrobial agents artificially added to bone cement.Conclusion The main pathogen of PJI after joint replacement is Staphylococcus epidermidis,which is ge-nerally resistant to penicillin and oxacillin,anti-infection treatment is mainly vancomycin combined with meropenem.

关 键 词：关节置换 假体周围感染 病原菌 耐药性 联合用药 

分 类 号：R181.32[医药卫生—流行病学]