金黄色葡萄球菌菌血症患者血源性人工关节感染的临床表现、危险因素和转归。

Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia.

机构信息

Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.

出版信息

Am J Med. 2016 Feb;129(2):221.e11-20. doi: 10.1016/j.amjmed.2015.09.006. Epub 2015 Oct 8.

DOI:10.1016/j.amjmed.2015.09.006

PMID:26453989

Abstract

BACKGROUND

Staphylococcus aureus bacteremia is a life-threatening condition that may lead to metastatic infection, including prosthetic joint infection.

METHODS

To assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a 5-year period at our institution. Patients with postsurgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded.

RESULTS

There were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (odds ratio [OR] 18.07; 95% confidence interval [CI] 2.64-infinity; P = .001), as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of ≥3 joint arthroplasties in place was associated with a nearly ninefold increased odds of hematogenous prosthetic joint infection as compared with those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; P = .012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infections diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia.

CONCLUSION

Prosthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia is rare.

摘要

背景

金黄色葡萄球菌菌血症是一种危及生命的疾病，可能导致转移性感染，包括人工关节感染。

方法

为了评估与血源性病原体人工关节感染相关的临床因素，我们回顾性分析了我院 5 年内首次发生金黄色葡萄球菌菌血症时存在关节置换术的所有患者。排除术后人工关节感染而无血源性病原体人工关节感染的患者。

结果

共有 85 名患者（143 个关节置换术）存在无人工关节感染（n = 50；58.8%）或至少一个关节置换术的血源性病原体人工关节感染（n = 35；41.2%）。与医院获得性金黄色葡萄球菌菌血症相比，社区获得性金黄色葡萄球菌菌血症患者发生血源性病原体人工关节感染的几率显著增加（比值比[OR]18.07；95%置信区间[CI]2.64-无限；P =.001），而医院获得性金黄色葡萄球菌菌血症患者则没有血源性病原体人工关节感染。在校正金黄色葡萄球菌菌血症分类后，与 1-2 个关节置换术相比，存在≥3 个关节置换术的患者发生血源性病原体人工关节感染的几率几乎增加了 9 倍（OR 8.55；95%CI 1.44-95.71；P =.012）。除了一个关节，所有发生人工关节感染的关节均至少有一个提示感染的临床特征。在金黄色葡萄球菌菌血症住院后中位 3.4 年的随访期间，又诊断出 4 例金黄色葡萄球菌人工关节感染。