Font-Vizcarra Lluís, Tornero Eduard, Bori Guillem, Bosch Jordi, Mensa Josep, Soriano Alex
Department of Orthopedics and Trauma Surgery, Parc Sanitari Sant Joan de Dèu, Sant Boi de Llobregat, Barcelona, Spain.
Int J Artif Organs. 2011 Sep;34(9):870-5. doi: 10.5301/ijao.5000026.
To evaluate the relationship between intraoperative cultures during hip arthroplasty, the different patient characteristics, and the risk of developing a prosthetic joint infection (PJI).
A prospective observational study was performed. Patients who underwent elective THA from March 2007 to March of 2011 were included. Three samples were taken just after arthrotomy: synovial fluid inoculated into blood culture flasks (SF), a tissue sample (TS), and a swab of peri- prosthetic tissue (S). Patients received standard antibiotic prophylaxis. The PJI rate within the first 3 months after arthroplasty was recorded.
402 prostheses were included in the study. Contamination rate of synovial fluid was 10.2%. The most frequent isolated microorganism was coagulase-negative staphylococci (CoNS) (32 out of 41). Body mass index (BMI) was the only host characteristic associated with positive intraoperative culture (p=0.009). The PJI rate was 3.7%. Variables associated with PJI in the univariate and multivariate analysis were: age =67 years (p=0.012 OR: 5.35 (1.45-19.81); CI95%) and a BMI =35 (p=0.002, OR: 7.7 (2.12-27.85) CI95%). PJI rate among patients with BMI<35 with negative and positive intraoperative cultures was 3% and 2.7%, respectively, however, the rate among patients with BMI = 35 was 15% and 25%, respectively.
A BMI =35 was associated with a higher risk of positive intraoperative culture during hip arthroplasty. In addition, a BMI ≥35 was independently associated with a high risk of PJI and the highest rate was documented among obese patients with positive intraoperative cultures.
评估髋关节置换术中的术中培养结果、不同患者特征与发生人工关节感染（PJI）风险之间的关系。
进行了一项前瞻性观察性研究。纳入了2007年3月至2011年3月期间接受择期全髋关节置换术（THA）的患者。在关节切开术后立即采集三份样本：接种于血培养瓶中的滑液（SF）、一份组织样本（TS）和一份假体周围组织拭子（S）。患者接受标准抗生素预防。记录置换术后前3个月内的PJI发生率。
本研究纳入了402个假体。滑液污染率为10.2%。最常分离出的微生物是凝固酶阴性葡萄球菌（CoNS）（41例中的32例）。体重指数（BMI）是与术中培养阳性相关的唯一宿主特征（p = 0.009）。PJI发生率为3.7%。单因素和多因素分析中与PJI相关的变量为：年龄≥67岁（p = 0.012，比值比：5.35（1.45 - 19.81）；95%置信区间）和BMI≥35（p = 0.002，比值比：7.7（2.12 - 27.85）95%置信区间）。BMI<35且术中培养阴性和阳性的患者中PJI发生率分别为3%和2.7%，然而，BMI = 35的患者中该发生率分别为15%和25%。
BMI = 35与髋关节置换术中术中培养阳性的较高风险相关。此外，BMI≥35与PJI的高风险独立相关，且在术中培养阳性的肥胖患者中记录到的发生率最高。
