Akgün Doruk, Perka Carsten, Trampuz Andrej, Renz Nora
Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Arch Orthop Trauma Surg. 2018 May;138(5):635-642. doi: 10.1007/s00402-018-2886-0. Epub 2018 Jan 19.
Periprosthetic joint infections (PJI) caused by pathogens, for which no biofilm-active antibiotics are available, are often referred to as difficult-to-treat (DTT). However, it is unclear whether the outcome of DTT PJI is worse than those of non-DTT PJI. We evaluated the outcome of DTT and non-DTT PJI in a prospective cohort treated with a two-stage exchange according to a standardized algorithm.
Patients with hip and knee PJI from 2013 to 2015 were prospectively included and followed up for ≥ 2 years. DTT PJI was defined as growth of microorganism(s) resistant to all available biofilm-active antibiotics. The Kaplan-Meier survival analysis was used to compare the probability of infection-free survival between DTT and non-DTT PJI and the 95% confidence interval (95% CI) was calculated.
Among 163 PJI, 30 (18.4%) were classified as DTT and 133 (81.6%) as non-DTT. At a mean follow-up of 33 months (range 24-48 months), the overall treatment success was 82.8%. The infection-free survival rate at 2 years was 80% (95% CI 61-90%) for DTT PJI and 84% (95% CI 76-89%) for non-DTT PJI (p = 0.61). The following mean values were longer in DTT PJI than in non-DTT PJI: hospital stay (45 vs. 28 days; p < 0.001), prosthesis-free interval (89 vs. 58 days; p < 0.001) and duration of antimicrobial treatment (151 vs. 117 days; p = 0.003).
The outcome of DTT and non-DTT PJI was similar (80-84%), however, at the cost of longer hospital stay, longer prosthesis-free interval and longer antimicrobial treatment. It remains unclear whether patients undergoing two-stage exchange with a long interval need biofilm-active antibiotics. Further studies need to evaluate the outcome in patients treated with biofilm-active antibiotics undergoing short vs. long interval.
由病原体引起的人工关节周围感染（PJI），若没有对生物膜有活性的抗生素可用，通常被称为难治性感染（DTT）。然而，目前尚不清楚DTT PJI的治疗结果是否比非DTT PJI更差。我们根据标准化算法，对接受两阶段置换治疗的前瞻性队列中的DTT和非DTT PJI的治疗结果进行了评估。
前瞻性纳入2013年至2015年期间患有髋部和膝部PJI的患者，并进行≥2年的随访。DTT PJI定义为对所有可用的对生物膜有活性的抗生素耐药的微生物生长。采用Kaplan-Meier生存分析比较DTT和非DTT PJI之间无感染生存的概率，并计算95%置信区间（95%CI）。
在163例PJI中，30例（18.4%）被归类为DTT，133例（81.6%）为非DTT。平均随访33个月（范围24 - 48个月），总体治疗成功率为82.8%。DTT PJI的2年无感染生存率为80%（95%CI 61 - 90%），非DTT PJI为84%（95%CI 76 - 89%）（p = 0.61）。DTT PJI的以下平均值比非DTT PJI更长：住院时间（45天对28天；p < 0.001）、无假体间隔时间（89天对58天；p < 0.001）和抗菌治疗持续时间（151天对117天；p = 0.003）。
DTT和非DTT PJI的治疗结果相似（80% - 84%），然而，代价是住院时间更长、无假体间隔时间更长和抗菌治疗时间更长。目前尚不清楚接受长间隔两阶段置换的患者是否需要对生物膜有活性的抗生素。进一步的研究需要评估接受短间隔和长间隔生物膜活性抗生素治疗的患者的治疗结果。
