Laboratoire polyvalent de biologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France.
Unité mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France.
Med Mal Infect. 2019 Oct;49(7):511-518. doi: 10.1016/j.medmal.2018.12.002. Epub 2019 Jan 25.
Enterobacter cloacae prosthetic joint infections (PJI) are rare and poorly documented.
We conducted a retrospective and monocentric study in an orthopedic unit supporting complex bone and joint infections. Between 2012 and 2016 we collected background, clinical, biological, and microbiological data from 20 patients presenting with prosthetic joint infection and positive for E. cloacae, as well as data on their surgical and medical treatment and outcome.
Infections were localized in the hip (n=14), knee (n=5), or ankle (n=1). The median time between arthroplasty and septic revision was three years. Fourteen patients (70%) had undergone at least two surgeries due to previous prosthetic joint infections. The median time between the last surgery and the revision for E. cloacae infection was 31 days. Eleven patients (55%) were infected with ESBL-producing strains. The most frequently used antibiotics were carbapenems (n=9), cefepime (n=7), quinolones (n=7), and fosfomycin (n=4). The infection was cured in 15 patients (78.9%) after a 24-month follow-up. Five patients had a recurrent infection with another microorganism and four patients had a relapse of E. cloacae infection. The global success rate was 52.7% (58.3% for DAIR and 75% for DAIR+ciprofloxacin).
Prosthetic joint infections due to E. cloacae usually occur early after the last prosthetic surgery, typically in patients with complex surgical and medical histories. The success rate seems to be increased when DAIR is associated with ciprofloxacin.
阴沟肠杆菌假体关节感染（PJI）较为罕见且记录较少。
我们在一家骨科病房进行了回顾性单中心研究，该病房可诊治复杂的骨与关节感染。2012 年至 2016 年，我们从 20 例阴沟肠杆菌阳性的假体关节感染患者中收集了背景、临床、生物学和微生物学数据，以及他们的手术和医疗治疗及结果数据。
感染部位位于髋关节（n=14）、膝关节（n=5）或踝关节（n=1）。关节置换术后至感染翻修的中位时间为 3 年。14 例患者（70%）因先前的假体关节感染至少进行了 2 次手术。上次手术至阴沟肠杆菌感染翻修的中位时间为 31 天。11 例患者（55%）感染的菌株产生 ESBL。最常使用的抗生素为碳青霉烯类（n=9）、头孢吡肟（n=7）、喹诺酮类（n=7）和磷霉素（n=4）。15 例患者（78.9%）在 24 个月的随访后感染得到治愈。5 例患者出现另一种微生物的复发性感染，4 例患者阴沟肠杆菌感染复发。总体成功率为 52.7%（DAIR 为 58.3%，DAIR+环丙沙星为 75%）。
阴沟肠杆菌引起的假体关节感染通常发生在上次假体手术后不久，通常发生在有复杂手术和医疗史的患者中。当 DAIR 与环丙沙星联合使用时，成功率似乎会提高。
