Eid Albert J, Berbari Elie F, Sia Irene G, Wengenack Nancy L, Osmon Douglas R, Razonable Raymund R
Division of Infectious Diseases, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Clin Infect Dis. 2007 Sep 15;45(6):687-94. doi: 10.1086/520982. Epub 2007 Aug 13.
Prosthetic joint infection (PJI) due to rapidly growing mycobacteria (RGM) is only occasionally encountered in clinical practice. Therefore, the optimal clinical management for this condition is unknown.
The medical records of patients who had PJI due to RGM during 1969-2006 were reviewed to summarize its clinical characteristics, treatment, and outcome.
Eight patients developed 9 episodes of PJI (7 episodes involving the knee and 1 each involving the hip or elbow) due to RGM at a median of 312 weeks (range, 1-170 weeks) after prosthesis implantation. Patients presented with joint pain (7 patients), joint swelling (7 patients), and fever (3 patients), accompanied by an elevated erythrocyte sedimentation rate (median, 70.5 mm/h) and C-reactive protein level (median, 6 mg/dL). Mycobacterium chelonae (n=3), Mycobacterium abscessus (n=2), Mycobacterium fortuitum (n=3), and Mycobacterium smegmatis (n=1) were isolated from the 9 infected joints. Seven of 9 prostheses were resected, whereas 2 were retained after surgical debridement. Six of 8 patients received > or = 1 active antimicrobial agent for at least 6 months. During a median follow-up period of 33 weeks (range, 2.6-326 weeks) after surgical intervention, no clinical or microbiological relapses were observed. Reimplantation was performed successfully for 2 of 6 patients who underwent resection arthroplasty. The 2 patients with retained prosthesis continued to receive prolonged courses of suppressive antimicrobial therapy.
RGM is a rare cause of PJI that should be suspected in patients with negative results of routine bacterial cultures. The combination of resection arthroplasty and antimicrobial therapy is the preferred approach. However, in cases involving retained prosthetic components, RGM infection may be suppressed with lifelong courses of effective antibiotic therapy.
由快速生长分枝杆菌（RGM）引起的人工关节感染（PJI）在临床实践中仅偶尔遇到。因此，针对这种情况的最佳临床管理方法尚不清楚。
回顾了1969年至2006年间因RGM导致PJI的患者的病历，以总结其临床特征、治疗方法和结果。
8例患者发生了9次因RGM导致的PJI（7次累及膝关节，1次累及髋关节或肘关节），发生时间为假体植入后中位312周（范围1至170周）。患者表现为关节疼痛（7例）、关节肿胀（7例）和发热（3例），同时红细胞沉降率升高（中位值70.5mm/h）和C反应蛋白水平升高（中位值6mg/dL）。从9个感染关节中分离出龟分枝杆菌（n = 3）、脓肿分枝杆菌（n = 2）、偶然分枝杆菌（n = 3）和耻垢分枝杆菌（n = 1）。9个假体中有7个被切除，而2个在手术清创后保留。8例患者中有6例接受了≥1种活性抗菌药物治疗至少6个月。在手术干预后的中位随访期33周（范围2.6至326周）内，未观察到临床或微生物学复发。6例行关节置换术的患者中有2例成功进行了再植入。2例保留假体的患者继续接受长期的抑制性抗菌治疗。
RGM是PJI的罕见病因，对于常规细菌培养结果为阴性的患者应怀疑此病。关节置换术和抗菌治疗相结合是首选方法。然而，在涉及保留假体部件的情况下，RGM感染可能通过终身有效的抗生素治疗得到抑制。
