Clesham Kevin, Hughes Andrew J, O' hEireamhoin Sven, Fleming Catherine, Murphy Colin G
Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Newcastle Road, Galway, Ireland.
Department of Infectious Diseases, Galway University Hospitals, Newcastle Road, Galway, Ireland.
Eur J Orthop Surg Traumatol. 2018 Oct;28(7):1369-1374. doi: 10.1007/s00590-018-2189-8. Epub 2018 Apr 10.
Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections.
Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay.
Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs.
Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.
人工关节感染（PJI）是关节成形术中最严重的并发症之一。多关节置换患者发生的第二部位PJI会增加发病率，许多患者需要进一步的翻修手术。我们旨在确定为何一些多关节患者会发生第二部位感染。
回顾了我院2004年至2017年的关节成形术数据库。识别出所有PJI病例，并纳入所有体内有一个以上人工关节的患者。我们记录了危险因素、致病微生物、手术次数和住院时间。
确定了44例符合标准的患者。4例（9.1%）发生了第二部位感染。8例（18.2%）发生了原发性PJI的再次感染。耐甲氧西林金黄色葡萄球菌（MRSA）携带状态阳性和全膝关节置换的PJI与再次感染的风险增加相关。发生进一步感染的患者比单纯PJI患者入院更频繁，住院时间更长。
这组患者的发病率较高，且医院资源使用较多。全膝关节置换的PJI和MRSA阳性状态与较高的再次感染率相关。早期识别这一易感染患者群体对于确保采取措施降低进一步感染风险至关重要。
