骨与关节非结核分枝杆菌感染的回顾性研究  

A retrospective study on non-tuberculous Mycobacterium infections in bone and joints

作　　者：陈仁德 杨恩慧 马琼 田永福 耿一心 李文红 张莎莎 李勇军 CHEN Ren-de;YANG En-hui;MA Qiong;TIAN Yong-fu;GENG Yi-xin;LI Wen-hong;ZHANG Sha-sha;LI Yong-jun(Department of Laboratory Medicine,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Zhengzhou 450001,China;Department of Laboratory Medicine,Henan Provincial People’s Hospital,Zhengzhou 450001,China;Department of Bone and Joint Infections,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Zhengzhou 450001,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)检验科,河南郑州450001 [2]河南省人民医院检验科,河南郑州450001 [3]河南省洛阳正骨医院(河南省骨科医院)骨与关节感染科,河南郑州450001

出　　处：《中国感染控制杂志》2023年第9期1027-1033,共7页Chinese Journal of Infection Control

摘　　要：目的 回顾性研究近五年某三甲骨伤专科医院骨与关节非结核分枝杆菌(NTM)感染的菌种分布、临床特征及诊疗信息,为骨与关节NTM感染临床诊疗与相关研究提供参考。方法 收集2016年1月—2020年12月诊断为骨与关节系统NTM感染患者的病历资料,筛选符合标准的病例,总结、分析菌种分布及不同类型感染者的基本特征、临床表现和治疗预后信息。结果 2016—2020年共确诊骨与关节NTM感染24例,其中,感染偶发分枝杆菌10例,脓肿分枝杆菌6例,龟脓肿分枝杆菌群、休斯顿分枝杆菌各3例,耻垢分枝杆菌、鸟分枝杆菌各1例。13例患者有不同程度基础疾病,感染部位涉及四肢各关节,最常见为膝关节、足关节感染,分别为9、7例。24例患者均出现脓肿及感染部位触压痛,少数出现局部皮温升高或全身发热情况。50.0%(12/24)患者有窦道形成,20.8%(5/24)患者出现肉芽肿。24例患者中,2例未进行外科手术,余22例均进行了外科手术治疗。所有患者均进行了抗菌药物加中医药内外结合辅助治疗,治愈时间中位数为129 d,治愈率为83.3%(20例)。1例患者检出病原菌后转院,1例因多器官功能衰竭死亡,2例治疗效果不佳。结论 及时、准确的早期病原学诊断能缩短骨与关节NTM感染的诊断周期,及时对症精准治疗,有效降低感染损伤,减轻患者痛苦。中医药辅助治疗可促进伤口愈合,缩短治疗疗程,减轻不良反应。Objective To retrospectively study the distribution of bacterial species,clinical characteristics,as well as diagnosis and treatment information of non-tuberculous Mycobacterium(NTM)infections in bone and joints in a tertiary orthopedic hospital over the past five years,providing reference for clinical diagnosis,treatment,and rela-ted research of NTM infections in bone and joints.Methods Clinical data of patients diagnosed with NTM infections in bone and joint systems from January 2016 to December 2020 were collected.Cases that met the criteria were selected.Distribution of bacterial species,basic characteristics,clinical manifestations,treatment and prognosis information of patients with different types of infections were summarized and analyzed.Results From 2016 to 2020,a total of 24 cases of NTM infections in bone and joints were diagnosed.Among them,Mycobacterium fortuitum was found in 10 cases,Mycobacterium abscessus in 6 cases,Mycobacterium chelonae-Mycobacterium abscessus group in 3 cases,Mycobacterium houstonense in 3 cases,Mycobacterium smegmatis in 1 case,and Mycobacterium avium in 1 case.13 patients had underlying diseases of varying degrees,and the infected sites involved various joints in the limbs,with the knee joint(n=9)and ankle joint(n=7)being the most common.All 24 patients presented abscesses and tenderness at the infected site,with a few cases showing local skin temperature elevation or systemic fever.50.0%(12/24)of patients had sinus formation,and 20.8%(5/24)had granulomas.Among the 24 patients,2 did not undergo surgery,while the other 22 underwent surgical treatment.All patients received both internal and external adjuvant treatment with antimicrobial agents combined with traditional Chinese medicine,with a median cure duration of 129 days and a cure rate of 83.3%(n=20).One patient was transferred to other hospital after pathogen detection,one died due to multiple organ failure,and two had poor treatment outcomes.Conclusion Timely and accurate early pathogenic diagnosis can shorten the diagn

关 键 词：非结核分枝杆菌 骨与关节感染 中医药辅助治疗 

分 类 号：R529.2[医药卫生—内科学] R378.91[医药卫生—临床医学]