Holzmann T, Schneider-Brachert W
Institut für Klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Orthopade. 2015 May;44(5):344-8. doi: 10.1007/s00132-015-3087-y.
Prosthetic joint infection is a rare but serious complication after arthroplasty, leading to prolonged hospitalization and repeated surgical intervention.
In this article, successful strategies for the rapid and accurate microbiological diagnosis of infection are reviewed. In the case of clinical suspicion of a prosthetic joint infection, at least a comprehensive clinical review of the patient's postoperative history, a physical examination, routine blood tests including white cell count, erythrocyte sedimentation rate, and C-reactive protein, and further investigation of the synovial-fluid leukocyte count and microbial culture are needed. Depending of the clinical signs of infection additional blood culture samples should be taken.
The gold standard to confirm infection is a surgical procedure with at least 5-6 biopsies from suspected areas for both microbial culture and histopathological examination. Culture results may be negative because of previous antimicrobial therapy, a low number of culturable organisms in biofilm formations, inappropriate culture medium, and prolonged transport time.
In any of these conditions, diagnosis with highly sensitive diagnostic techniques such as polymerase chain reaction should be considered for the identification of the causative agent in order to establish the most appropriate antimicrobial treatment options.
人工关节感染是关节置换术后一种罕见但严重的并发症，会导致住院时间延长和反复进行手术干预。
本文综述了快速准确进行感染微生物诊断的成功策略。在临床怀疑人工关节感染的情况下，至少需要对患者的术后病史进行全面临床评估、进行体格检查、进行包括白细胞计数、红细胞沉降率和C反应蛋白在内的常规血液检查，以及进一步检查滑液白细胞计数和进行微生物培养。根据感染的临床体征，应采集额外的血培养样本。
确认感染的金标准是进行手术，从疑似区域至少采集5 - 6份活检样本进行微生物培养和组织病理学检查。由于先前的抗菌治疗、生物膜形成中可培养微生物数量少、培养基不合适以及运输时间过长，培养结果可能为阴性。
在任何这些情况下，为了确定最恰当的抗菌治疗方案，应考虑使用聚合酶链反应等高灵敏度诊断技术进行诊断以识别病原体。
