Rush University Medical Center, Chicago, IL, USA.
J Am Acad Orthop Surg. 2010 Dec;18(12):760-70. doi: 10.5435/00124635-201012000-00006.
No preferred test for diagnosis of periprosthetic joint infection exists, and the algorithm for the workup of patients suspected of infection remains unclear. The work group evaluated the available literature to determine the role of each diagnostic modality and devise a practical algorithm that allows physicians to reach diagnosis of periprosthetic joint infection. Ten of the 15 recommendations have strong or moderate evidence in support. These include matters involving erythrocyte sedimentation rate and C-reactive protein level testing, knee and hip aspiration, and stopping the use of antibiotics prior to obtaining intra-articular cultures. The group recommends against the use of intraoperative Gram stain but does recommend the use of frozen sections of peri-implant tissues in reoperation patients in whom infection has not been established, as well as multiple cultures in reoperation patients being assessed for infection. The group recommends against initiating antibiotic treatment in patients with suspected infection until after joint cultures have been obtained, but recommends that prophylactic preoperative antibiotics not be withheld in patients at lower probability for infection.
目前尚无诊断人工关节周围感染的首选检测方法，疑似感染患者的检查流程仍不明确。工作组评估了现有文献，以确定每种诊断方法的作用，并制定一个实用的算法，使医生能够诊断人工关节周围感染。其中 10 条建议有强有力或中等强度的证据支持。这些建议包括红细胞沉降率和 C 反应蛋白水平检测、膝关节和髋关节穿刺，以及在获得关节内培养物之前停止使用抗生素。工作组不建议在术中进行革兰氏染色，但建议在未确诊感染的再次手术患者中使用植入物周围组织的冰冻切片，以及对疑似感染的再次手术患者进行多次培养。工作组不建议在获得关节培养物之前开始对疑似感染的患者使用抗生素治疗，但建议对感染可能性较低的患者不要预防性地术前使用抗生素。
