Tornero Eduard, García-Oltra Ester, García-Ramiro Sebastían, Martínez-Pastor Juan C, Bosch Jordi, Climent Consuelo, Morata Laura, Camacho Pilar, Mensa Josep, Soriano Alex
Department of Orthopedic Surgery and Traumatology, Hospital Clinic of Barcelona, Barcelona, Spain.
Int J Artif Organs. 2012 Oct;35(10):884-92. doi: 10.5301/ijao.5000148.
To evaluate the specific characteristics, outcome, and predictors of failure of prosthetic joint infections (PJI) due to S. aureus and coagulase-negative staphylococci (CNS) treated with open debridement and retention of the implant.
PJI due to S. aureus or CNS prospectively registered in a database from 1999 to 2009 were retrospectively reviewed. During the study period, 106 patients met the inclusion criteria. The mean follow-up period was 3.8 years and for at least 2 years in all patients. The failure rate was 23.6% (25 out of 106). The only variable significantly associated with failure in the global cohort was polymicrobial infection (38.7% vs. 17.3%, p = 0.024). Fifty-seven (53.8%) patients had an infection due to S. aureus and 49 (46.2%) due to CNS. Among S. aureus infections, 95% corresponded to primary arthroplasties while 98% of PJIs due to CNS were after revision arthroplasties (p<0.001). C-reactive protein was significantly higher in PJI due to S. aureus (9.5 mg/dl vs. 4.9 mg/dl, p = 0.007). The rate of methicillin-resistance (8.8% vs. 59.2%, p<0.001) and fluoroquinolone-resistance (15.8% vs. 34.7%, p = 0.005) was significantly higher in CNS infections. The global failure rate was higher in S. aureus infections (28% vs. 18.3. p = 0.26). In S. aureus infections, patients diagnosed within the first 15 days after joint arthroplasty (p = 0.031) and with bacteremia (p = 0.046) had poor pro-gnosis. In CNS infections only the location of the prosthesis (knee 27.6% vs. hip 5%, p = 0.045) was associated with failure.
PJIs due to S. aureus were mainly in primary arthroplasties; they had a higher inflammatory response; and the strains were more susceptible to fluoroquinolones and methicillin than CNS infections. S. aureus infections had a higher failure rate than CNS infections, however, the difference was not statistically significant. There were few factors associated with failure and they were different in S. aureus and CNS infections.
评估采用开放清创并保留植入物治疗的金黄色葡萄球菌和凝固酶阴性葡萄球菌（CNS）所致人工关节感染（PJI）的具体特征、结局及失败预测因素。
对1999年至2009年前瞻性登记在数据库中的金黄色葡萄球菌或CNS所致PJI进行回顾性分析。研究期间，106例患者符合纳入标准。平均随访期为3.8年，所有患者至少随访2年。失败率为23.6%（106例中的25例）。在整个队列中，与失败显著相关的唯一变量是混合微生物感染（38.7%对17.3%，p = 0.024）。57例（53.8%）患者感染由金黄色葡萄球菌引起，49例（46.2%）由CNS引起。在金黄色葡萄球菌感染中，95%为初次关节置换术后感染，而CNS所致PJI中98%为翻修关节置换术后感染（p<0.001）。金黄色葡萄球菌所致PJI患者的C反应蛋白显著更高（9.5mg/dl对4.9mg/dl，p = 0.007）。CNS感染中耐甲氧西林率（8.8%对59.2%，p<0.001）和耐氟喹诺酮率（15.8%对34.7%，p = 0.005）显著更高。金黄色葡萄球菌感染的总体失败率更高（28%对18.3%，p = 0.26）。在金黄色葡萄球菌感染中，关节置换术后15天内确诊的患者（p = 0.031）和发生菌血症的患者（p = 0.046）预后较差。在CNS感染中，仅假体位置（膝关节27.6%对髋关节5%，p = 0.045）与失败相关。
金黄色葡萄球菌所致PJI主要发生在初次关节置换术后；炎症反应更高；与CNS感染相比，菌株对氟喹诺酮类和甲氧西林更敏感。金黄色葡萄球菌感染的失败率高于CNS感染，然而，差异无统计学意义。与失败相关的因素较少，且在金黄色葡萄球菌和CNS感染中有所不同。
