a Department of Orthopaedic Surgery , Odense University Hospital , Odense C , Denmark.
b The Lundbeck Centre for Fast-Track Hip and Knee Arthroplasty , Copenhagen University Hospital Rigshospitalet , Copenhagen Ø , Denmark.
Infect Dis (Lond). 2017 Nov-Dec;49(11-12):824-830. doi: 10.1080/23744235.2017.1350878. Epub 2017 Jul 8.
Revision of infected knee arthroplasties is associated with high failure rates (30-40%). An understanding of the microbiology is important to optimize treatment and outcome. We describe microbiological diagnostic practice and diagnosis in revision of infected knee arthroplasties.
One hundred and two partial revisions (open debridement and exchange of tibial insert) and 213 two-stage procedures performed due to infection in 275 patients from 1 July 2011 to 30 June 2013 were included and analysed by linkage to data from a nationwide registry on microbiological test results.
78 (24.8%) revisions were culture negative, 192 (60.9%) showed monomicrobial growth and 43 (14.3%) polymicrobial growth. Staphylococcus aureus was the most frequent isolate in mono-culture in 70 (22.2%) revisions and in polymicrobial culture in 15 revisions with a total frequency of 27.0%. Only one case (1.4%) of methicillin-resistance was registered. Coagulase-negative staphylococci (CoNS) were frequent, sole pathogen in 65 revisions and in polymicrobial cultures in 28 revisions with a total frequency of 29.5%. A pre-operative knee aspiration was performed in 50% and preoperative blood cultures were performed in 22% of cases. In 73% of the preoperative knee-aspirations bacteriological findings were fully or partially in accordance with intraoperative cultures. In 54% of the later re-revisions due to infection (treatment-failures) the cultured species differed from or was not detected at index revision surgery.
The 25% culture negative cases in combination with only 50% preoperative knee aspirations and prevailing high failure rates confirm the need for improvement of diagnostic practice and treatment of infected knee arthroplasties.
感染性膝关节翻修术的失败率较高（30-40%）。了解微生物学对于优化治疗和预后非常重要。我们描述了感染性膝关节翻修术的微生物学诊断实践和诊断方法。
纳入了 275 例患者的 102 例部分翻修术（开放性清创术和胫骨插入物更换）和 213 例两期手术，这些患者因感染于 2011 年 7 月 1 日至 2013 年 6 月 30 日接受治疗，并通过与全国微生物学检测结果登记处的数据进行链接进行分析。
78 例（24.8%）翻修术的培养结果为阴性，192 例（60.9%）显示单一致病菌生长，43 例（14.3%）显示多致病菌生长。金黄色葡萄球菌是 70 例单培养（22.2%）和 15 例多培养（总频率 27.0%）中最常见的分离菌。仅登记了 1 例（1.4%）耐甲氧西林金黄色葡萄球菌。凝固酶阴性葡萄球菌（CoNS）是常见的病原体，在 65 例单独发生，在 28 例多培养中发生，总频率为 29.5%。50%的病例进行了术前膝关节抽吸，22%的病例进行了术前血培养。在 73%的术前膝关节抽吸中，细菌学发现与术中培养完全或部分相符。在 54%的后续因感染而进行的再翻修术（治疗失败）中，培养出的菌种与索引翻修术中的菌种不同或未检出。
25%的培养阴性病例，加上只有 50%的术前膝关节抽吸，以及较高的失败率，证实需要改进感染性膝关节翻修术的诊断实践和治疗。
