Nodzo Scott R, Boyle K Keely, Bhimani Samrath, Duquin Thomas R, Miller Andy O, Westrich Geoffrey H
Department of Orthopedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Department of Orthopedics, University at Buffalo, Buffalo, NY USA.
HSS J. 2017 Jul;13(2):159-164. doi: 10.1007/s11420-016-9528-2. Epub 2016 Sep 29.
() has become increasingly recognized as a cause of periprosthetic joint infection (PJI).
QUESTIONS/PURPOSES: It is not currently known if the clinical presentation of varies depending on the joint being infected.
We retrospectively reviewed patients infected with after total hip, knee, and shoulder arthroplasty from two institutions. Patients were classified as having a PJI based on the Musculoskeletal Infection Society criteria and were excluded if they had a polymicrobial culture. Patient demographics, preoperative laboratory values, and microbiology data were analyzed.
Eighteen knees, 12 hips, and 35 shoulders with a PJI were identified. Median ESR was significantly higher in the knee (38.0 mm/h, IQR 18.0-58.0) and hip (33.5 mm/h, IQR 15.3-60.0) groups compared to the shoulder group (11.0 mm/h, IQR 4.5-30.5). C-reactive protein levels were higher in the knee (2.0 mg/dl, IQR 1.3-8.9) and hip (2.4 mg/dl, IQR 0.8-4.9) groups compared to the shoulder group (0.7 mg/dl, IQR 0.6-1.5). Median synovial fluid WBC was significantly higher in the knee group than shoulder group (19,950 cells/mm, IQR 482-60,063 vs 750 cells/mm, IQR 0-2825, respectively). Peripheral blood WBC levels were similar between groups, as was mean time of growth in culture. Clindamycin resistance was present in all groups.
The manner in which a patient with PJI presents is joint specific. Inflammatory markers were significantly higher in the knee and hip groups compared to the hip and shoulder groups, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism.
（）已越来越被认为是假体周围关节感染（PJI）的一个病因。
问题/目的：目前尚不清楚（）的临床表现是否因感染的关节不同而有所差异。
我们回顾性分析了来自两家机构的全髋关节、膝关节和肩关节置换术后感染（）的患者。根据肌肉骨骼感染学会的标准将患者分类为患有PJI，若患者有多种微生物培养结果则予以排除。分析患者的人口统计学资料、术前实验室检查值和微生物学数据。
共确定了18例膝关节、12例髋关节和35例肩关节患有（）PJI。与肩关节组（11.0mm/h，四分位间距4.5 - 30.5）相比，膝关节组（38.0mm/h，四分位间距18.0 - 58.0）和髋关节组（33.5mm/h，四分位间距15.3 - 60.0）的血沉中位数显著更高。与肩关节组（0.7mg/dl，四分位间距0.6 - 1.5）相比，膝关节组（2.0mg/dl，四分位间距1.3 - 8.9）和髋关节组（2.4mg/dl，四分位间距0.8 - 4.9）的C反应蛋白水平更高。膝关节组滑膜液白细胞中位数显著高于肩关节组（分别为19,950个细胞/mm，四分位间距482 - 60,063与750个细胞/mm，四分位间距0 - 2825）。各组外周血白细胞水平相似，培养中（）生长的平均时间也相似。所有组均存在克林霉素耐药。
（）PJI患者的表现方式因关节而异。与髋关节和肩关节组相比，膝关节组和髋关节组的炎症标志物显著更高，长达14天的长时间厌氧培养对于准确识别这种微生物是必要的。
