Bone and Joint Infection Unit, Hospital Clínic, IDIBAPS, Barcelona, Spain.
Clin Microbiol Infect. 2014 Nov;20(11):1219-24. doi: 10.1111/1469-0691.12721.
The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.
本研究旨在回顾 18 家欧洲 6 国医院的 203 例肠球菌性人工关节感染（PJI）的临床特征及结局。回顾性分析 1999 年 1 月至 2012 年 7 月间诊断为肠球菌性 PJI 的患者，记录人口统计学、合并症、临床特征、微生物学数据、手术治疗及结局等相关信息。采用单变量和多变量分析。共纳入 203 例患者，平均年龄（标准差）为 70.4（13.6）岁。59 例（29.1%）感染发生于关节置换术后 30 天内，44 例（21.7%）发生于术后 31-90 天，54 例（26.6%）发生于术后 91-2 年，43 例（21%）发生于术后 2 年后。176 例（89%）分离出粪肠球菌。107 例（54%）为混合感染。任何合并症（OR 2.53，95%CI 1.18-5.40，p=0.01）和发热（OR 2.65，95%CI 1.23-5.69，p=0.01）与治疗失败独立相关。唯一与缓解相关的因素是 2 年后诊断的感染（OR 0.25，95%CI 0.09-0.71，p=0.009）。结论：70%以上的肠球菌性 PJI 发生于关节置换术后 2 年内，近 50%的患者存在至少一种合并症，且感染多为混合感染（54%）。总体失败率为 44%，存在合并症、发热及关节置换术后 2 年内诊断的患者预后较差。
