Hadeed Michael M, MacDonell J Ryan, Dempsey Ian J, Moore Christopher C, Browne James A
Department of Orthopaedic Surgery (M.M.H., J.R.M., I.J.D., and J.A.B.) and Division of Infectious Disease and International Health, Department of Medicine (C.C.M.), University of Virginia, Charlottesville, Virginia.
JBJS Case Connect. 2017 Oct-Dec;7(4):e74. doi: 10.2106/JBJS.CC.16.00250.
We report the successful treatment of a Nocardia cyriacigeorgica periprosthetic joint infection (PJI) that occurred at the site of a total knee arthroplasty. To our knowledge, this organism has not previously been reported in the literature as a cause of PJI. Given the need for a prolonged duration of treatment for this organism (a minimum of 6 to 12 months), modifications to the standard 2-stage revision were made in consultation with infectious-disease specialists.
PJI is a devastating complication that leads to substantial patient morbidity and utilization of health-care resources. As the number of PJIs continues to rise, new and increasingly challenging infections are being encountered more frequently. In the case described here, the second stage of the revision was delayed for 6 months and antibiotics were continued for 7 months after the second operation, for a total of 13 months of antibiotic treatment. The present report provides a possible treatment plan for patients infected with durable bacteria similar to N. cyriacigeorgica.
我们报告了1例发生在全膝关节置换术部位的乔治西诺卡菌假体周围关节感染（PJI）的成功治疗案例。据我们所知，该病原体此前在文献中尚未被报道为PJI的病因。鉴于针对该病原体需要较长疗程的治疗（至少6至12个月），我们与感染病专家协商后对标准的两阶段翻修术进行了调整。
PJI是一种具有破坏性的并发症，会导致患者出现严重发病情况并消耗大量医疗资源。随着PJI的数量持续上升，新的、越来越具有挑战性的感染越来越频繁地出现。在本病例中，翻修术的第二阶段推迟了6个月，第二次手术后继续使用抗生素7个月，抗生素治疗总时长为13个月。本报告为感染类似于乔治西诺卡菌的耐药菌的患者提供了一种可能的治疗方案。
