Nodzo Scott R, Frisch Nicholas B
Mike O'Callaghan Medical Center, 4700 N. Las Vegas Blvd, Las Vegas, NV, 89109, USA.
Ascension Crittenton Hospital, Rochester, MI, 48304, USA.
Curr Rev Musculoskelet Med. 2018 Sep;11(3):341-346. doi: 10.1007/s12178-018-9496-x.
Organism identification and antibiotic selection remain a critical component of periprosthetic joint infection (PJI) treatment. Prior to organism identification and/or the availability of antibiotic sensitivities, empiric antibiotics are routinely started. A basic understanding of a region or institutions antibiogram is paramount for selection of an empiric treatment regimen. Evolving antibiogram results and regional antibiotic resistance are important to follow as this may change antibiotic selection in some patient populations.
The Clinical Laboratory and Standards Institute (CLSI) has created guidelines and standards for the creation and maintenance of antibiograms that should be followed by institutions. The infecting organism during PJI may be different in acute vs chronic infections and empiric therapy may change depending on the timing. Antibiotic prophylaxis for major procedures in certain patient populations should be critically evaluated based on regional and national antibiogram results. The CLSI guides recommendations and antibiotic resistance testing techniques and should be consulted when creating an antibiogram. The local and regional antibiogram should be consulted prior to administration of empiric and prophylactic antibiotics.
微生物鉴定和抗生素选择仍然是人工关节周围感染（PJI）治疗的关键组成部分。在进行微生物鉴定和/或获得抗生素敏感性结果之前，通常会开始经验性使用抗生素。对某个地区或机构的抗菌谱有基本了解对于选择经验性治疗方案至关重要。随着抗菌谱结果的不断变化以及区域抗生素耐药性的变化，跟踪这些情况很重要，因为这可能会改变某些患者群体的抗生素选择。
临床实验室标准协会（CLSI）已经制定了关于创建和维护抗菌谱的指南和标准，各机构应遵循这些标准。PJI期间的感染微生物在急性感染与慢性感染中可能有所不同，经验性治疗可能会根据时间而改变。对于某些患者群体的 major procedures（此处可能是“大手术”之意，不太明确准确含义，需结合更多背景信息）的抗生素预防，应根据区域和国家抗菌谱结果进行严格评估。CLSI指导推荐意见和抗生素耐药性检测技术，在创建抗菌谱时应参考其建议。在使用经验性和预防性抗生素之前，应参考当地和区域抗菌谱。
