Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
Curr Opin Infect Dis. 2019 Apr;32(2):102-112. doi: 10.1097/QCO.0000000000000534.
Prosthetic joint infections (PJIs) represent one of the most disastrous complications in prosthetic surgery, requiring long hospitalization, prolonged antimicrobial treatment and repeated surgical interventions. No gold standard test to formulate diagnosis exist. A combination of high index of suspicion, physical examination, microbiological and biohumoral investigations is required. Therapeutical approach should be based on a multidisciplinary team. In our center, a two-stage approach is preferred. As regards the choice of the empirical antibiotic backbone, individual risk factors for multiple-drug resistant (MDR) pathogens should be considered. Several studies enhance the possibility to shorten the length of antibiotic couses.
Some interesting improvements have been made in the setting of PJIs management. As regards diagnosis, novel biomarkers and nuclear imaging are acquiring more importance. Molecular biology techniques also offer the possibility to formulate rapid microbiological identification. The pattern of PJIs is evolving towards higher rates of MDR causes. During the last decade, a number of new antibiotic molecules with activity against MDRs have been approved. Some of them are also available either in oral formulation or as long-acting compounds, offering the opportunity for early patient's discharge, with expected healthcare costs saving.
Management of PJIs still represents a major threat for clinicians. Improvements in surgical techniques and antibiotic pipeline promise to revolutionize the approach in next years. Despite data from our experience confirm the efficacy of shorter antibiotic courses and the value of new molecules, randomized clinical trials are lacking. More data are needed in order to modify the routine clinical practice.
人工关节感染（PJI）是人工关节置换术后最严重的并发症之一，需要长期住院、延长抗菌治疗和反复手术干预。目前尚无明确的诊断标准，需要结合高度怀疑、体格检查、微生物学和生物化学检查来进行诊断。治疗方法应基于多学科团队。在我们中心，首选两阶段治疗方法。在选择经验性抗生素治疗时，应考虑到多重耐药（MDR）病原体的个体危险因素。一些研究表明抗生素疗程可以缩短。
在 PJI 管理方面取得了一些有趣的进展。在诊断方面，新型生物标志物和核医学成像越来越重要。分子生物学技术也提供了快速微生物鉴定的可能性。PJI 的模式正在向更高的 MDR 病原体发生率发展。在过去十年中，许多具有抗 MDR 活性的新型抗生素分子已被批准使用。其中一些还可提供口服制剂或长效制剂，为患者提前出院提供了机会，预计可节省医疗保健费用。
人工关节感染的管理仍然对临床医生构成重大威胁。手术技术和抗生素研发的改进有望在未来几年彻底改变治疗方法。尽管我们的经验数据证实了缩短抗生素疗程和新分子的有效性，但仍缺乏随机临床试验。为了改变常规临床实践，还需要更多的数据。
