不同葡萄球菌所致骨科植入物感染的转归。

Outcome of orthopedic implant infections due to different staphylococci.

机构信息

Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

出版信息

Int J Infect Dis. 2010 Oct;14(10):e913-8. doi: 10.1016/j.ijid.2010.05.014. Epub 2010 Aug 21.

DOI:10.1016/j.ijid.2010.05.014

PMID:20729115

Abstract

BACKGROUND

Comparisons of different staphylococci in orthopedic implant infections have rarely been reported. In this study we assessed total joint arthroplasty infections and other orthopedic implant infections due to methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative staphylococci (CoNS).

METHODS

This was a retrospective study performed at the Geneva University Hospitals for the period January 1996 to June 2008.

RESULTS

There were 44 infections due to MRSA, 58 due to MSSA, and 61 due to CoNS. Overall cure was achieved in 57% (25/44) of MRSA infections, 72% (42/58) of MSSA infections, and 82% (50/61) of CoNS infections, after a minimum follow-up of 1 year. In the subgroup of arthroplasty infections only, cure was achieved in 39% (7/18) of MRSA, 60% (15/25) of MSSA, and 77% (30/39) of CoNS episodes. In multivariate analysis, arthroplasty (odds ratio (OR) 0.2, 95% confidence interval (95% CI) 0.1-0.6) and MRSA infections (OR 0.3, 95% CI 0.1-0.9) were inversely associated with overall cure for all implants. CoNS infection (OR 3.0, 95% CI 1.2-8.0) and the insertion of a new implant (OR 4.5, 95% CI 1.6-13.1) were associated with higher cure results. Methicillin resistance, immunosuppression, sex, age, duration of antibiotic therapy, one-stage revision, rifampin use, and total number of surgical interventions did not influence cure. MRSA-infected patients had more post-infection sequelae than patients with MSSA or CoNS (Chi-square test 13/44 vs. 93/119, OR 3.4, 95% CI 1.3-8.9, p=0.004).

CONCLUSIONS

In orthopedic implant infections, S. aureus is more virulent than CoNS. MRSA has the worst outcome and CoNS the best.

摘要

背景

关于骨科植入物感染中不同葡萄球菌的比较鲜有报道。本研究评估了耐甲氧西林金黄色葡萄球菌（MRSA）、甲氧西林敏感金黄色葡萄球菌（MSSA）和凝固酶阴性葡萄球菌（CoNS）导致的全关节置换术感染和其他骨科植入物感染。

方法

这是一项在 1996 年 1 月至 2008 年 6 月期间在日内瓦大学医院进行的回顾性研究。

结果

共有 44 例感染由 MRSA 引起，58 例由 MSSA 引起，61 例由 CoNS 引起。经过至少 1 年的随访，57%（25/44）的 MRSA 感染、72%（42/58）的 MSSA 感染和 82%（50/61）的 CoNS 感染获得了完全治愈。在仅为关节置换术感染的亚组中，18 例 MRSA 感染中有 39%（7/18）、25 例 MSSA 感染中有 60%（15/25）和 39 例 CoNS 感染中有 77%（30/39）获得了完全治愈。多变量分析表明，关节置换术（比值比（OR）0.2，95%置信区间（95%CI）0.1-0.6）和 MRSA 感染（OR 0.3，95%CI 0.1-0.9）与所有植入物的总体治愈率呈负相关。CoNS 感染（OR 3.0，95%CI 1.2-8.0）和植入新植入物（OR 4.5，95%CI 1.6-13.1）与更高的治愈率相关。耐甲氧西林、免疫抑制、性别、年龄、抗生素治疗时间、一期翻修、利福平使用和手术干预总数均不影响治愈率。MRSA 感染患者比 MSSA 或 CoNS 感染患者有更多的感染后后遗症（卡方检验 13/44 与 93/119，OR 3.4，95%CI 1.3-8.9，p=0.004）。