Vergidis P, Lesnick T G, Kremers W K, Razonable R R
Division of Infectious Diseases, Department of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Transpl Infect Dis. 2012 Aug;14(4):380-6. doi: 10.1111/j.1399-3062.2011.00708.x. Epub 2012 Jan 20.
The clinical features and outcome of prosthetic joint infection (PJI) among solid organ transplant (SOT) recipients have not been characterized. We performed a retrospective, matched case-control study to examine potential risk factors.
We reviewed cases of PJI among transplant recipients who were evaluated at the Mayo Clinic between 1989 and 2009. Cases were matched to non-infected controls based on transplant type, prosthetic joint type, and order of organ transplantation/joint implantation.
Among 367 patients with both a joint prosthesis and an SOT, there were 12 cases of infection in those receiving immunosuppression. These occurred in 8 renal recipients, 3 liver recipients, and 1 heart transplant recipient. Six subjects had hip and 6 had knee arthroplasty infections. The observed time to prosthesis failure ranged from 0.5 to 148 months after implantation. Gram-positive bacteria (staphylococci and streptococci) caused the infection in 8 subjects. Two cases were caused by nontuberculous mycobacteria, whereas the remaining 2 cases were culture-negative in the setting of antimicrobial use. We did not find a statistically significant association between obesity, diabetes mellitus, or antimicrobial prophylaxis (given in the setting of immunosuppression) and development of PJI. A marginal association was seen between surgical site infection and the risk of PJI; however, this did not reach statistical significance.
In our series, infection was mainly caused by gram-positive bacterial pathogens, similar to the commonly encountered organisms in the immunocompetent host, although opportunistic pathogens were also isolated.
实体器官移植（SOT）受者中人工关节感染（PJI）的临床特征和结局尚未得到描述。我们进行了一项回顾性配对病例对照研究，以检查潜在的危险因素。
我们回顾了1989年至2009年间在梅奥诊所接受评估的移植受者中PJI的病例。根据移植类型、人工关节类型以及器官移植/关节植入顺序，将病例与未感染的对照进行配对。
在367例同时进行关节置换和SOT的患者中，接受免疫抑制的患者中有12例发生感染。这些感染发生在8例肾移植受者、3例肝移植受者和1例心脏移植受者中。6例患者发生髋关节置换感染，6例患者发生膝关节置换感染。观察到的假体失败时间为植入后0.5至148个月。革兰氏阳性菌（葡萄球菌和链球菌）导致8例患者感染。2例由非结核分枝杆菌引起，其余2例在使用抗菌药物的情况下培养结果为阴性。我们未发现肥胖、糖尿病或抗菌药物预防（在免疫抑制情况下使用）与PJI的发生之间存在统计学上的显著关联。手术部位感染与PJI风险之间存在边缘关联；然而，这未达到统计学显著性。
在我们的系列研究中，感染主要由革兰氏阳性细菌病原体引起，这与免疫功能正常宿主中常见的病原体相似，尽管也分离出了机会性病原体。
