Abad C L, Haleem A
Department of Medicine, Section of Infectious Diseases, University of the Philippines, Philippine General Hospital, Taft Ave., Manila, Philippines.
Department of Internal Medicine, Division of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, WI, 53705, USA.
Curr Infect Dis Rep. 2018 May 22;20(7):15. doi: 10.1007/s11908-018-0622-0.
Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management.
Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial. A high clinical index of suspicion for PJI combined with data from multiple preoperative and intraoperative tests enables timely diagnosis and treatment. Biomarkers, molecular methods, and implant sonication are currently adjunctive to traditional diagnostic techniques. Shorter courses of antimicrobial therapies as well as the role of chronic suppressive therapy need confirmation by randomized controlled trials. Existing practices for preoperative dental prophylaxis and treatment of asymptomatic bacteriuria warrant revision based on evidence arguing against risk for PJI.
人工关节感染（PJI）是一种罕见但严重的并发症，常被误诊。我们旨在强调PJI诊断和抗菌治疗的细微差别，并在关键管理领域提供清晰的指导。
目前关于PJI的研究集中在诊断生物标志物、分子技术和植入物超声处理在降低培养阴性率方面的潜在作用。抗菌治疗的最佳持续时间仍存在争议。对PJI的高度临床怀疑指数与术前和术中多项检查的数据相结合，能够实现及时诊断和治疗。生物标志物、分子方法和植入物超声处理目前是传统诊断技术的辅助手段。抗菌治疗的较短疗程以及慢性抑制治疗的作用需要随机对照试验来证实。基于反对PJI风险的证据，现有的术前牙科预防和无症状菌尿治疗方法需要修订。
