Tornero Eduard, Riba Josep, Garcia-Ramiro Sebastian
Department of Orthopaedic and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Open Orthop J. 2013 Jun 14;7:211-8. doi: 10.2174/1874325001307010211. Print 2013.
Chronic systemic illnesses such as diabetes mellitus, chronic kidney disease (CKD), liver cirrhosis, neoplasia, etc. have been clearly associated with high rates of SWI. However, the exact mechanisms underlying these observations are still under investigation. Chronic kidney disease (CKD) is a growing problem in our society. Many of these patients will require an arthroplasty and it appears that the prosthetic infection risk for these types of patients is much higher than in the normal population. The risk of complications due to infection seems to be lower in patients with kidney transplants than in patients undergoing haemodialysis. Both prophylaxis and treatment of infection in patients with CKD should be carried out with a strict monitoring of potentially nephrotoxic antibiotics. The literature on the prognosis and risk of infection in patients with haematopoietic stem cell transplant is scarce and occasionally contradictory. The optimal time for the surgery should be determined by taking into account the immunological state of the patient and should be avoided, as much as possible, during the first year after the HSCT. Child's classification system is the most widely used method of stratifying the surgical risk for patients with cirrhosis; the infection appeared to be associated in a statistically significant way with advanced age and a Child B pre-operative classification. The prevention of prosthetic joint infections in HIV-infected patients should not be significantly different from the prevention for any other patient. Those patients that receive adequate antiretroviral treatment and periodic laboratory control show infection rates and periprosthetic complications that are similar to those for patients not affected by HIV. Therefore, the patient's level of immunodeficiency is the most important prognostic factor for prosthetic infection. The particular immunological condition of these patients can lead to infections due to particular microorganisms that immunocompetent patients do not have to deal with. Of all possibilities, because of their frequency and difficulty to treat, infections caused by methicillin-resistant S. aureus and fungus are highlighted.
糖尿病、慢性肾脏病（CKD）、肝硬化、肿瘤等慢性全身性疾病已被明确与较高的手术部位感染（SWI）发生率相关。然而，这些观察结果背后的确切机制仍在研究中。慢性肾脏病（CKD）在我们的社会中是一个日益严重的问题。这些患者中的许多人将需要进行关节置换术，而且这类患者的假体感染风险似乎比正常人群高得多。肾移植患者因感染导致并发症的风险似乎低于接受血液透析的患者。CKD患者感染的预防和治疗都应在严格监测潜在肾毒性抗生素的情况下进行。关于造血干细胞移植患者感染的预后和风险的文献很少，且偶尔相互矛盾。手术的最佳时机应根据患者的免疫状态来确定，并且在造血干细胞移植（HSCT）后的第一年应尽可能避免手术。Child分级系统是对肝硬化患者手术风险进行分层最广泛使用的方法；感染似乎与高龄和术前Child B分级在统计学上有显著关联。HIV感染患者假体关节感染的预防与其他患者的预防不应有显著差异。那些接受充分抗逆转录病毒治疗和定期实验室检查的患者显示出的感染率和假体周围并发症与未感染HIV的患者相似。因此，患者的免疫缺陷水平是假体感染最重要的预后因素。这些患者特殊的免疫状况可能导致由免疫功能正常的患者无需应对的特定微生物引起的感染。在所有可能性中，由于耐甲氧西林金黄色葡萄球菌和真菌引起的感染频率高且难以治疗，因而备受关注。
