The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2012 Oct;470(10):2708-16. doi: 10.1007/s11999-012-2374-8.
Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined.
QUESTIONS/PURPOSES: We asked (1) what is the proportion of enterococcal PJI in our institutes; and (2) what is the rate of infection control in these cases?
We respectively identified 22 and 14 joints with monomicrobial and polymicrobial PJI, respectively, caused by enterococcus. The diagnosis of PJI was made based on the presence of sinus tract or two positive intraoperative cultures. PJI was also considered in the presence of one positive intraoperative culture and abnormal serology. We determined the proportion of enterococcal PJI and management and control of infection in these cases. Minimum followup was 1.5 years (mean, 3.2 years).
The proportion of monomicrobial enterococcal PJI was 2.3% (22 of 955 cases of PJI). Mean number of surgeries was two (range, 1-4). Initial irrigation and débridement was performed in 10 joints and eight patients needed reoperation. Seven of the 16 joints were initially managed using two-stage exchange arthroplasty and did not need further operation. Six patients had a definitive resection arthroplasty. Salvage surgeries (fusion and above-knee amputation) were performed in three cases (8%). The infection was ultimately controlled in 32 of the 36 patients.
Management of enterococcal PJI is challenging and multiple operations may need to be performed to control the infection.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
肠球菌性人工关节假体周围感染（PJI）在关节置换术后较为罕见。这些病例通常在其他病原体引起的 PJI 系列中报告。由于很少有研究专门针对肠球菌性 PJI，因此这些病例的感染管理和控制尚未得到很好的定义。
问题/目的：我们提出了以下两个问题：（1）我们机构中肠球菌性 PJI 的比例是多少；（2）这些病例的感染控制率是多少？
我们分别鉴定了由肠球菌引起的 22 例和 14 例单纯性和混合性 PJI 关节。PJI 的诊断基于窦道或两次术中培养均为阳性。如果存在一次术中培养阳性和异常血清学结果，也会考虑 PJI。我们确定了肠球菌性 PJI 的比例以及这些病例的感染管理和控制情况。最低随访时间为 1.5 年（平均 3.2 年）。
单纯性肠球菌性 PJI 的比例为 2.3%（955 例 PJI 中有 22 例）。手术次数平均为 2 次（范围 1-4 次）。10 个关节行初始灌洗清创术，8 例患者需要再次手术。16 个关节中有 7 个最初采用两期关节置换术治疗，无需进一步手术。6 例患者行确定性切除术。3 例（8%）患者行挽救性手术（融合术及以上）。36 例患者中有 32 例最终感染得到控制。
肠球菌性 PJI 的治疗具有挑战性，可能需要多次手术才能控制感染。
IV 级，治疗性研究。有关作者指南的完整说明，请参阅证据水平。
