根据治疗算法对全髋关节置换术相关感染进行管理。

Management of infection associated with total hip arthroplasty according to a treatment algorithm.

作者信息

Giulieri S G, Graber P, Ochsner P E, Zimmerli W

机构信息

Medical University Clinic, Kantonsspital, CH-4410 Liestal, Switzerland.

出版信息

Infection. 2004 Aug;32(4):222-8. doi: 10.1007/s15010-004-4020-1.

DOI:10.1007/s15010-004-4020-1

PMID:15293078

Abstract

BACKGROUND

An algorithm for the management of hip arthroplasty-associated infections was validated in a cohort study.

PATIENTS

60 patients with 63 episodes of total hip arthroplasty-associated infections observed from 1985 to 2001 were included. The treatment algorithm was based on the time of manifestation, pathogenesis, and condition of implant and soft tissue. Three treatment options were proposed, namely debridement with retention, one-stage and two-stage replacement.

RESULTS

The median patients' age was 72 years, the median follow-up 28 months; 29% were early, 41% delayed, and 30% late infections, 57% of the infections were exogenously and 43% hematogenously acquired. The overall success rate for the first treatment attempt was 83% (52/63). Patients treated according to the algorithm had a better outcome than the others (44/50 = 88% vs 8/13 = 62%, Relative risk (RR) 0.31, 95% confidence interval (CI): 0.11-0.86, p < 0.03); those treated with adequate antimicrobial therapy had a better success rate (87% vs. 50%, p < 0.01).

CONCLUSION

The proposed algorithm defines a rational surgical/antibiotic treatment strategy.

摘要

背景

一项关于髋关节置换术相关感染管理的算法在队列研究中得到验证。

患者

纳入了1985年至2001年期间观察到的60例患者的63次全髋关节置换术相关感染。治疗算法基于感染表现时间、发病机制以及植入物和软组织状况。提出了三种治疗方案，即保留假体清创术、一期置换和二期置换。

结果

患者年龄中位数为72岁，随访中位数为28个月；29%为早期感染，41%为延迟感染，30%为晚期感染，57%的感染为外源性获得，43%为血源性获得。首次治疗尝试的总体成功率为83%（52/63）。按照算法治疗的患者比其他患者结局更好（44/50 = 88% 对比 8/13 = 62%，相对风险（RR）0.31，95%置信区间（CI）：0.11 - 0.86，p < 0.03）；接受充分抗菌治疗的患者成功率更高（87% 对比 50%，p < 0.01）。