假体周围感染菌株分布的临床研究  

Clinical study on the distribution of pathogen strains around periprosthetic joint infection

作　　者：孙小波 张世标 刘玉婷 曾意荣[3] SUN Xiao-bo;ZHANG Shi-biao;LIU Yu-ting;ZENG Yi-rong(Department of Sports Medicine,Ganzhou Traditional Chinese Medicine Hospital;Gannan Medical University,Ganzhou,Jiangxi 341000;Department of Orthopaedics,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong 510405)

机构地区：[1]赣州市中医院运动医学科 [2]赣南医科大学,江西赣州341000 [3]广州中医药大学第一附属医院人工关节与膝关节科,广东广州510405

出　　处：《赣南医科大学学报》2024年第9期905-910,共6页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：赣州市科技局指导性科技计划项目(GZ2020ZSF357)。

摘　　要：目的:分析假体周围感染菌株分布及药敏特点,为实验研究病原菌株选取、药物选取提供依据。方法:收集2010年8月至2016年12月广州中医药大学第一附属医院人工关节与膝关节科收治的因假体周围感染(Periprosthetic joint infection,PJI)行人工关节二期翻修患者的临床资料,分析患者菌株分布情况及药敏试验结果。结果:本研究共纳入77例患者,检出菌株阳性患者51例(66.23%),其中革兰氏阳性菌株43例(84.31%)、革兰氏阴性菌株6例(11.77%)、真菌2例(3.92%)。药敏实验显示:⑴革兰氏阳性菌甲氧西林敏感的金黄色葡萄球菌(Methicillin sensitive staphylococcus aureus,MSSA)、耐甲氧西林的金黄色葡萄球菌(Methicillin resistant staphylococcus aureus,MRSA)和表皮葡萄球菌对青霉素的耐药率分别为84.62%、75.00%和100.00%,对万古霉素、利奈唑胺、达福普汀、替加环素均敏感。MRSA和表皮葡萄球菌对苯唑西林耐药率分别为100.00%、87.50%,MSSA则为敏感。MSSA和表皮葡萄球菌对莫西沙星、庆大霉素敏感,MRSA仅对庆大霉素敏感。MSSA对环丙沙星、左氧氟沙星、利福平、呋喃妥因、复方磺胺甲唑敏感。⑵革兰阴性菌主要为肺炎克雷伯菌、大肠埃希菌,肺炎克雷伯菌对环丙沙星、庆大霉素、呋喃妥因、氨苄西林、头孢唑林、氨曲南耐药;对头孢他啶、哌拉西林/他唑巴坦、亚胺培南、阿米卡星、厄他培南敏感。大肠埃希菌对氨苄西林、头孢唑林耐药;对呋喃妥因、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、亚胺培南、厄他培南、头孢替坦敏感。⑶真菌有拟平滑假丝酵母菌和热带假丝酵母菌,均对两性霉素B、氟康唑、伏立康唑、伊曲康唑、5-氟胞嘧啶敏感。结论:革兰氏阳性球菌为PJI主要病原菌,其中MSSA为主要革兰氏阳性球菌,对多种抗生素表现出较高的耐药性,真菌对多种抗真菌药物敏感。Objective:To analyze the distribution of pathogen strains and the characteristics of drug sensitivity around periprosthetic joint infection(PJI),providing a basis for the selection of pathogen strains and drugs in experimental studies.Methods:The clinical data of patients who underwent two-stage revision of artificial joints due to periprosthetic joint infection(PJI)in the Department of Artificial Joints and Knee Joints of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2010 to December 2016 were collected.The strain distribution and results of drug sensitivity tests of these patients were analyzed.Results:A total of 77 patients were included in this study,among whom 51 patients(66.23%)had positive strain detections.There were 43 cases(84.31%)of Gram-positive strains,6 cases(11.77%)of Gram-negative strains,and 2 cases(3.92%)of fungi.The drug sensitivity tests revealed that:⑴The resistance rates of methicillin-sensitive staphylococcus aureus(MSSA),methicillin-resistant staphylococcus aureus(MRSA),and staphylococcus epidermidis to penicillin in Gram-positive bacteria were 84.62%,75.00%,and 100.00%,respectively.They were all sensitive to vancomycin,linezolid,daptomycin,and tigecycline.The resistance rates of MRSA and staphylococcus epidermidis to oxacillin were 100.00%、87.50%,while MSSA was sensitive.MSSA and staphylococcus epidermidis were sensitive to moxifloxacin and gentamicin,while MRSA was only sensitive to gentamicin.MSSA was sensitive to ciprofloxacin,levofloxacin,rifampicin,nitrofurantoin,and cotrimoxazole.⑵The main Gram-negative bacteria were Klebsiella pneumoniae and Escherichia coli.The resistance rates of Klebsiella pneumoniae to ciprofloxacin,gentamicin,nitrofurantoin,ampicillin,cefazolin,and aztreonam;the sensitivity rates to ceftazidime,piperacillin/tazobactam,imipenem,amikacin,and ertapenem.The resistance rates of Escherichia coli to ampicillin and cefazolin;the sensitivity rates to nitrofurantoin,ceftazidime,cefepime,piperacillin/tazobactam,imipenem,ertap

关 键 词：感染 假体周围 菌株分布 药敏试验 抗药性 细菌 

分 类 号：R687.3[医药卫生—骨科学]