膝关节置换术后迟发性多微生物、革兰氏阴性和耐甲氧西林感染的结果。
Results after late polymicrobial, gram-negative, and methicillin-resistant infections in knee arthroplasty.
机构信息
Cirugía Ortopédica y Traumatología, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Océano Antártico 41, Tres Cantos, 28760 Madrid, Spain.
出版信息
Clin Orthop Relat Res. 2010 May;468(5):1229-36. doi: 10.1007/s11999-009-1224-9.
BACKGROUND
Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied.
QUESTIONS/PURPOSES: This study compared the results of treatment of knee arthroplasty infections by single versus polymicrobial isolates, Gram-positive versus Gram-negative, and methicillin-resistant versus -sensitive Staphylococci.
METHODS
We prospectively followed 47 patients with late knee arthroplasty infections. The mean age was 72 years (range, 20-87 years). The treatment protocol included two-stage exchange and a combination of two oral antibiotics given for 6 months. Minimum followup was 1 year (average, 4.8 +/- 3 years; range, 1-12 years). Control of the infection was judged by absence of clinical, serologic, and radiologic signs of infection. The functional outcome was evaluated by Knee Society score at the last followup.
RESULTS
Infection was controlled in all 15 patients with polymicrobial and in 28 of 32 (88%) with monomicrobial infections, in eight of nine patients with Gram-negative and in 35 of 38 (92%) with Gram-positive isolates. Control was also achieved in 22 of 25 patients (88%) infected by methicillin-resistant Staphylococci and in 14 of 14 by methicillin-sensitive Staphylococci. The Knee Society scores averaged 81-63 in patients with polymicrobial infections and were higher than in monomicrobial infections (75-52). The mean KSS was 85-59 in Gram-negative infections compared to 75-55 in Gram-positive infections. The mean KSS was similar in methicillin-resistant (78-54) and methicillin-sensitive Staphylococci (73-56) infections.
CONCLUSIONS
Polymicrobial and Gram-negative infections can be controlled in late knee arthroplasty infections. On the other hand, infections by methicillin-resistant Staphylococci are less likely to be controlled by the regimens we used.
LEVEL OF EVIDENCE
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
先前关于高毒力病原体引起的膝关节置换术后感染的研究表明预后不良。多微生物和革兰氏阴性感染的研究较少。
问题/目的：本研究比较了单一致病菌与多微生物分离株、革兰氏阳性菌与革兰氏阴性菌以及耐甲氧西林与敏感金黄色葡萄球菌引起的膝关节置换术后感染的治疗结果。
方法
我们前瞻性随访了 47 例晚期膝关节置换术后感染患者。平均年龄为 72 岁（范围 20-87 岁）。治疗方案包括两期置换和两种口服抗生素联合使用 6 个月。最低随访时间为 1 年（平均 4.8 +/- 3 年；范围 1-12 年）。通过无临床、血清学和影像学感染迹象来判断感染是否得到控制。最后一次随访时采用膝关节学会评分评估功能结局。
结果
在所有 15 例多微生物感染患者和 32 例（88%）单微生物感染患者中，8 例革兰氏阴性患者和 38 例（92%）革兰氏阳性患者中，感染均得到控制。在 25 例耐甲氧西林金黄色葡萄球菌感染患者中，有 22 例（88%）和 14 例耐甲氧西林金黄色葡萄球菌感染患者中（100%）感染得到控制。多微生物感染患者的膝关节学会评分平均为 81-63，高于单微生物感染患者（75-52）。革兰氏阴性感染的平均 KSS 为 85-59，革兰氏阳性感染为 75-55。耐甲氧西林和甲氧西林敏感金黄色葡萄球菌感染的平均 KSS 相似（分别为 78-54 和 73-56）。
结论
多微生物和革兰氏阴性感染可在晚期膝关节置换术后感染中得到控制。另一方面，我们使用的方案不太可能控制耐甲氧西林金黄色葡萄球菌感染。
证据水平
二级，预后研究。有关证据水平的完整描述，请参见作者指南。
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