Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Arthroplasty. 2013 Oct;28(9):1486-9. doi: 10.1016/j.arth.2013.02.021. Epub 2013 Apr 12.
It is unclear if recurrent periprosthetic joint infection (PJI) is a result of failed pathogen eradication. This study addresses this issue. We identified 92 patients from three institutions who failed two-stage exchange. Cultured organisms at each stage of treatment were compared to determine whether these were persistent or new infections. Only twenty-nine of the 92 patients (31.5%) had identical organisms at treatment failure. Of the failures associated with Staphylococcus as the original infecting organism, 37% (25 of 67) failed due to the same organism compared to only 16% (four of 25) caused by other organisms. Positive cultures at reimplantation and poor health status were associated with higher rates of recurrent infection due to new organisms. Successful management of PJI with a two-stage exchange must stress minimization of comorbid risk factors that may contribute to the low success rate of PJI treatment and recurrence of infection.
目前尚不清楚复发性人工关节周围感染（PJI）是否是病原体清除失败的结果。本研究旨在解决这一问题。我们从三家机构中确定了 92 名接受了两阶段翻修手术的患者，比较了每个阶段的培养物以确定这些感染是持续性的还是新的感染。在 92 名患者中，只有 29 名（31.5%）在治疗失败时具有相同的病原体。在与金黄色葡萄球菌作为初始感染病原体相关的失败中，37%（67 例中的 25 例）是由相同的病原体引起的，而只有 16%（25 例中的 4 例）是由其他病原体引起的。再植入时的阳性培养物和较差的健康状况与新病原体引起的更高复发感染率相关。两阶段翻修手术治疗 PJI 的成功管理必须强调减少可能导致 PJI 治疗和感染复发成功率低的合并症风险因素。
