Vilchez Félix, Martínez-Pastor Juan C, García-Ramiro Sebastián, Bori Guillem, Tornero Eduard, García Esther, Mensa Josep, Soriano Alex
Department of Orthopedics of Hospital Clínic of Barcelona, Hospital Clínic Universitari, IDIBAPS, Barcelona, Spain.
Int J Artif Organs. 2011 Sep;34(9):863-9. doi: 10.5301/ijao.5000029.
To review patients with a hematogenous and early post-surgical prosthetic joint infection (PJI) due to S. aureus treated with debridement and retention of the implant and to compare their clinical characteristics and outcome.
From January 2000 all patients with a prosthetic joint infection treated in a single-center were prospectively registered and followed-up. All potentially variables associated with outcome were recorded. For the present study, cases with a hematogenous or early post-surgical PJI due to S. aureus treated with debridement and at least 2 years of follow-up were reviewed. Cox regression model to identify factors associated with outcome were applied.
12 hematogenous and 53 early post-surgical PJI due to S. aureus were included. Number of patients presenting with fever, leucocyte count, C-reactive protein concentration, and the number of bacteremic patients were significantly higher in hematogenous infections while the number of polymicrobial infections was lower in hematogenous than in early post-surgical infections. The global failure rate in hematogenous and early post-surgical PJI was 58.7% and 24.5%, respectively (p=0.02). The Cox regression model identified hematogenous infections (OR: 2.57, CI95%: 1.02-6.51, p=0.04) and the need of a second debridement (OR: 4.61, CI95%: 1.86-11.4, p=0.001) as independent predictors of failure.
Hematogenous infections were monomicrobial and had more severe symptoms and signs of infection than early post-surgical PJI. Hematogenous PJI due to S. aureus, using debridement with implant retention, had a worse outcome than early post-surgical infections.
回顾因金黄色葡萄球菌导致血源性及术后早期人工关节感染（PJI）且接受清创并保留植入物治疗的患者，比较他们的临床特征及预后。
自2000年1月起，对在单中心接受人工关节感染治疗的所有患者进行前瞻性登记及随访。记录所有与预后相关的潜在变量。对于本研究，回顾了因金黄色葡萄球菌导致血源性或术后早期PJI且接受清创并至少随访2年的病例。应用Cox回归模型确定与预后相关的因素。
纳入了12例血源性及53例术后早期因金黄色葡萄球菌导致的PJI。血源性感染患者出现发热、白细胞计数、C反应蛋白浓度以及菌血症患者数量显著更高，而血源性感染中多微生物感染的数量低于术后早期感染。血源性及术后早期PJI的总体失败率分别为58.7%和24.5%（p = 0.02）。Cox回归模型确定血源性感染（比值比：2.57，95%置信区间：1.02 - 6.51，p = 0.04）及需要进行二次清创（比值比：4.61, 95%置信区间：1.86 - 11.4, p = 0.001）为失败的独立预测因素。
血源性感染为单一微生物感染，与术后早期PJI相比具有更严重的感染症状和体征。因金黄色葡萄球菌导致的血源性PJI，采用保留植入物的清创治疗，其预后比术后早期感染更差。
