Orthopedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.
Int Orthop. 2012 May;36(5):1065-71. doi: 10.1007/s00264-011-1366-8. Epub 2011 Oct 5.
Osteoarticular infections due to methicillin-susceptible Staphylococcus aureus (MSSA) or its methicillin-resistant variant (MRSA) are feared due to treatment failures. According to clinical experience, Pseudomonas aeruginosa may reveal less long-term remission than S. aureus.
A case-controlled study comparing outcomes of osteoarticular infections due to P. aeruginosa vs S. aureus was performed at Geneva University Hospitals.
A total of 111 S. aureus (including 37 MRSA) and 20 P. aeruginosa osteoarticular infections were analysed in 131 patients: arthroplasties (n = 38), fracture fixation devices (n = 56), native joint arthritis (n = 7) and osteomyelitis without implant (n = 30). The median active follow-up time was 4 years. The patients underwent a median number of two surgical interventions for P. aeruginosa infections compared to two for S. aureus (two for MRSA), while the median duration of antibiotic treatment was 87 days for P. aeruginosa and 46 days for S. aureus infections (58 days for MRSA) (all p > 0.05). Overall, Pseudomonas-infected patients tended towards a lower remission rate than those infected with S. aureus (12/20 vs 88/111; p = 0.06). This was similar when P. aeruginosa was compared with MRSA alone (12/20 vs 30/37; p = 0.08). In multivariate logistic regression analyses adjusting for case mix, odds ratios (OR) for remission were as follows: P. aeruginosa vs S. aureus [OR 0.4, 95% confidence interval (CI) 0.1-1.2], number of surgical interventions (OR 0.6, 95% CI 0.5-1.0) and duration of antibiotic treatment (OR 1.0, 95% CI 1.0-1.0).
Despite a similar number of surgical interventions and longer antibiotic treatment, osteoarticular infections due to P. aeruginosa tended towards a lower remission rate than infections due to S. aureus in general or MRSA in particular.
由于治疗失败，耐甲氧西林金黄色葡萄球菌（MSSA）或其耐甲氧西林变体（MRSA）引起的骨关节炎感染令人担忧。根据临床经验，铜绿假单胞菌引起的骨关节炎感染的长期缓解率可能低于金黄色葡萄球菌。
在日内瓦大学附属医院进行了一项病例对照研究，比较了铜绿假单胞菌和金黄色葡萄球菌引起的骨关节炎感染的结果。
共分析了 131 例患者的 111 例金黄色葡萄球菌（包括 37 例 MRSA）和 20 例铜绿假单胞菌骨关节感染：关节置换术（n=38）、骨折固定装置（n=56）、原发性关节关节炎（n=7）和无植入物的骨髓炎（n=30）。中位活跃随访时间为 4 年。与金黄色葡萄球菌感染（MRSA 为 2 次）相比，铜绿假单胞菌感染患者接受的中位手术干预次数为 2 次，而铜绿假单胞菌感染的抗生素治疗中位持续时间为 87 天，金黄色葡萄球菌感染为 46 天（MRSA 为 58 天）（均 P＞0.05）。总体而言，铜绿假单胞菌感染患者的缓解率低于金黄色葡萄球菌感染患者（12/20 比 88/111；P=0.06）。当将铜绿假单胞菌与 MRSA 单独比较时，结果相似（12/20 比 30/37；P=0.08）。在调整病例组合的多变量逻辑回归分析中，缓解的优势比（OR）如下：铜绿假单胞菌与金黄色葡萄球菌[OR 0.4，95%置信区间（CI）0.1-1.2]、手术干预次数（OR 0.6，95%CI 0.5-1.0）和抗生素治疗持续时间（OR 1.0，95%CI 1.0-1.0）。
尽管手术干预次数相似且抗生素治疗时间更长，但铜绿假单胞菌引起的骨关节感染的缓解率总体上低于金黄色葡萄球菌感染，尤其是 MRSA 感染。
