Holleyman Richard J, Baker Paul, Charlett Andre, Gould Kate, Deehan David J
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
Health Education North East, Newcastle upon Tyne, NE15 8NY, UK.
Knee Surg Sports Traumatol Arthrosc. 2016 Oct;24(10):3080-3087. doi: 10.1007/s00167-015-3539-2. Epub 2015 Apr 1.
This study aimed to delineate epidemiology of infecting microorganism genus in first-time revision knee arthroplasty for indication of periprosthetic joint infection in England and Wales using linked registry data.
From the National Joint Registry database for England and Wales, a consecutive series of primary knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for periprosthetic infection were identified (n = 2810). Each case was then linked to microbiology data held by Public Health England in order to identify infecting microorganism at time of revision surgery established from intra-operative cultures. Following data linkage, 403 culture results at time of revision surgery were identified in a group of 331 patients. The demographic characteristics of five microorganism groups were compared: pure staphylococcus (single genus), pure streptococcus (single genus), other gram-positive infections (single genus), gram-negative infections (single genus) and mixed genus infections.
Staphylococcus species was the most common organism genus isolated after revision of a primary implant for infection and present in 72 % of cases overall (71.3 % of patients with a single-genus infection and 76.8 % of patients with mixed genus infection). A pure staphylococcal infection was present in 59 % of all cases. A single-genus infection was responsible for infection in 83.1 % of cases, and mixed genera were responsible in 16.9 % of cases. A significant difference was observed for mean age at primary procedure in the cohort of patients where there was an isolated pure streptococcal infection (73.2 years) when compared to gram-negative infections (65.0 years). No other significant differences were observed between microorganism groups in terms of BMI, gender, ASA grade, indication for primary procedure and primary implant characteristics.
Staphylococci were the most commonly isolated organism species responsible for periprosthetic infection of primary arthroplasty in England and Wales. This information can be used by surgeons to benchmark and audit their own practice against national, publicly available data. Furthermore, this study has shown that even when using the largest national databases available, there is a substantial volume of missing data. Antimicrobial resistance represents a growing clinical problem with significant health and social costs. In order to counteract this threat, this study would advocate the consolidation of national microbial data in order to guide effective strategies towards targeting and combating the threat of antimicrobial resistance.
IV.
本研究旨在利用关联登记数据，描述英格兰和威尔士初次翻修膝关节置换术中用于假体周围感染指征的感染微生物属的流行病学情况。
从英格兰和威尔士国家关节登记数据库中，识别出2003年4月至2014年1月期间连续进行的一系列初次膝关节置换术，这些手术随后因假体周围感染进行了翻修（n = 2810）。然后将每个病例与英国公共卫生部门持有的微生物学数据相链接，以便确定翻修手术时从术中培养物中确定的感染微生物。数据链接后，在331名患者的一组中确定了403份翻修手术时的培养结果。比较了五个微生物组的人口统计学特征：纯葡萄球菌（单一属）、纯链球菌（单一属）、其他革兰氏阳性感染（单一属）、革兰氏阴性感染（单一属）和混合属感染。
葡萄球菌属是初次植入物因感染翻修后分离出的最常见微生物属，总体上存在于72%的病例中（单一属感染患者中的71.3%和混合属感染患者中的76.8%）。所有病例中有59%存在纯葡萄球菌感染。单一属感染导致83.1%的病例感染，混合属感染导致16.9%的病例感染。与革兰氏阴性感染（65.0岁）相比，在孤立的纯链球菌感染队列中，初次手术时的平均年龄存在显著差异（73.2岁）。在微生物组之间，在体重指数、性别、美国麻醉医师协会分级、初次手术指征和初次植入物特征方面未观察到其他显著差异。
葡萄球菌是英格兰和威尔士初次关节置换术假体周围感染中最常分离出的微生物种类。外科医生可利用这些信息，对照全国公开可用的数据来衡量和审核自己的做法。此外，本研究表明，即使使用现有的最大型国家数据库，也存在大量缺失数据。抗菌药物耐药性是一个日益严重的临床问题，会带来巨大的健康和社会成本。为了应对这一威胁，本研究主张整合国家微生物数据，以指导针对和对抗抗菌药物耐药性威胁的有效策略。
IV级。
