原发性关节感染与关节假体周围感染病原学  

Etiological characteristics of primary joint infection and periprosthetic joint infection

作　　者：姜福贵 伍俊峰 杨标 吴中恒 周平 JIANG Fu-gui;WU Jun-feng;YANG Biao;WU Zhong-heng;ZHOU Ping(Guizhou Qiandongnan Prefecture People's Hospital,Qiandongnan Prefecture,Guizhou 556000,China)

机构地区：[1]贵州省黔东南州人民医院骨科,贵州黔东南州556000

出　　处：《中华医院感染学杂志》2023年第24期3762-3765,共4页Chinese Journal of Nosocomiology

基　　金：贵州省科学技术厅黔科合基础(ZK[2022]544)。

摘　　要：目的 本研究调查关节假体周围感染与原发性关节感染的微生物谱差异,并根据病原体分布差异指导制定更准确治疗原则。方法 评估2017年1月-2022年1月贵州省黔东南州人民医院骨科接受关节治疗患者,共纳入167例关节患者培养阳性滑液样本,对病原体分布进行分析,针对广泛使用的抗菌药物组合检查抗菌药物敏感性情况。结果 研究共纳入106例关节假体周围感染,61例原发性关节感染;金黄色葡萄球菌是关节假体周围感染最常见的致病病原体(34.4%),其次为表皮葡萄球菌,两组病原体分布比较有统计学差异(P<0.001);对于关节假体周围感染,庆大霉素+万古霉素(86.3%)、克拉维酸+糖肽(90.2%),哌拉西林/他唑巴坦+糖肽(88.5%)联合用药对经验治疗有效,与原发性关节感染相似(分别为82.3%、86.7%及88.6%)。结论 在关节假体周围感染和原发性关节感染中,葡萄球菌和革兰阴性菌占感染大多数;经验性抗菌治疗应重点关注关节假体周围感染和原发性关节感染葡萄球菌和革兰阴性菌的覆盖范围,庆大霉素+万古霉素、克拉维酸+糖肽或哌拉西林/他唑巴坦+糖肽等经验性联合治疗是原发性和关节假体周围感染患者的有效抗菌药物策略。OBJECTIVE To investigate the difference in microbial spectrum between patients with periprosthetic joint infection and native joint infection, and to formulate more accurate treatment principles based on it. METHODS A total of 167 patients who received joint treatment in the People′s Hospital of Qiandongnan Prefecture in Guizhou from Jan 2017 to Jan 2022 were evaluated. Bacteria-positive synovial fluid samples were collected and the distribution of pathogens was analyzed. The antimicrobial susceptibility testing for of antibiotic combinations was performed.RESULTS A total of 106 cases of periprosthetic infection and 61 cases of native joint infection were included in the study. Staphylococcus aureus was the most common pathogen of periprosthetic joint infection(34.4%), followed by Staphylococcus epidermidis. The distribution of pathogens between the two groups was statistically different(P<0.001). The antibiotic combinations of gentamicin-vancomycin(86.3%), co-amoxiclav-glycopeptide(90.2%), and piperacillin/tazobactam-glycopeptide(88.5%) were empirically effective for periprosthetic joint infections, which were similar to native joint infections(82.3%, 86.7%, and 88.6%, respectively). CONCLUSION Gram-negative bacteria are the main pathogens in periprosthetic infections and primary joint infections. Empiric antibacterial therapy should focus on the coverage of Staphylococcus and gram-negative bacteria in periprosthetic infection and native joint infection. Antibotic combinations of gentamicin-vancomycin, co-amoxiclav-glycopeptide and piperacillin/tazobactam-glycopeptide for the empirical treatment is an effective strategy for patients with primary and periprosthetic infection.

关 键 词：关节假体周围感染 病原菌谱 滑液 假体 原发性关节感染 

分 类 号：R619.3[医药卫生—外科学]