Cunningham Daniel J, Kavolus Joseph J, Bolognesi Michael P, Wellman Samuel S, Seyler Thorsten M
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
J Arthroplasty. 2017 Jun;32(6):1984-1990.e5. doi: 10.1016/j.arth.2017.01.027. Epub 2017 Jan 26.
Periprosthetic hip infection treatment remains a significant challenge for orthopedics. Some studies have suggested that methicillin resistance and gram-negative organism type are associated with increased treatment failure. The aim of this research is to determine if specific organisms were associated with poor outcomes in treatment for hip periprosthetic infection.
Records were reviewed of all patients between 2005 and 2015 who underwent treatment for infected partial or total hip arthroplasty. Characteristics of each patient's treatment course were determined including baseline characteristics, infecting organism(s), infection status at final follow-up, surgeries for infection, and time in hospital. Baseline characteristics and organisms that were associated with clinical outcomes in univariate analysis were incorporated into multivariable outcomes models.
When compared with patients infected with other organism(s), patients infected with the following organisms had significantly decreased infection-free rates: Pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA), and Proteus. Infection with certain organisms was associated with 1.13-2.58 additional surgeries: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, MRSA, Pseudomonas, Peptostreptococcus, Klebsiella, Candida, diphtheroids, Propionibacterium acnes, and Proteus species. Specific organisms were associated with 8.56-24.54 additional days in hospital for infection: methicillin-sensitive S aureus, coagulase-negative Staphylococcus, Proteus, MRSA, Enterococcus, Pseudomonas, Klebsiella, beta-hemolytic Streptococcus, and diphtheroids. Higher comorbidity score was also associated with greater length of hospitalization.
MRSA, Pseudomonas, and Proteus were associated with all 3 outcomes of lower infection-free rate, more surgery, and more time in hospital in treatment for hip periprosthetic infection. Organism-specific outcome information may help individualize patient-physician discussions about the expected course of treatment for hip periprosthetic infection.
人工髋关节感染的治疗仍是骨科面临的一项重大挑战。一些研究表明，耐甲氧西林和革兰氏阴性菌类型与治疗失败率增加有关。本研究的目的是确定特定病原体是否与人工髋关节感染治疗效果不佳相关。
回顾了2005年至2015年间所有接受感染性部分或全髋关节置换术治疗的患者的记录。确定了每位患者治疗过程的特征，包括基线特征、感染病原体、末次随访时的感染状态、感染手术及住院时间。将单因素分析中与临床结局相关的基线特征和病原体纳入多变量结局模型。
与感染其他病原体的患者相比，感染以下病原体的患者无感染率显著降低：铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌（MRSA）和变形杆菌。感染某些病原体与额外增加1.13 - 2.58次手术相关：甲氧西林敏感金黄色葡萄球菌、凝固酶阴性葡萄球菌、MRSA、铜绿假单胞菌、消化链球菌、克雷伯菌、念珠菌、类白喉杆菌、痤疮丙酸杆菌和变形杆菌属。特定病原体与感染后额外增加8.56 - 24.54天住院时间相关：甲氧西林敏感金黄色葡萄球菌、凝固酶阴性葡萄球菌、变形杆菌、MRSA、肠球菌、铜绿假单胞菌、克雷伯菌、β - 溶血性链球菌和类白喉杆菌。较高的合并症评分也与更长的住院时间相关。
MRSA、铜绿假单胞菌和变形杆菌与人工髋关节感染治疗的所有3个结局相关，即较低的无感染率、更多的手术和更长的住院时间。特定病原体的结局信息可能有助于医患个体化讨论人工髋关节感染的预期治疗过程。
