Department of Infectious Diseases, AORN Dei Colli, Naples, Italy.
Eur Rev Med Pharmacol Sci. 2019 Apr;23(2 Suppl):59-64. doi: 10.26355/eurrev_201904_17475.
Pathogens colonizing the intestinal or urinary tract such as enterococci or Gram-negative bacilli can cause prosthetic joint infection (PJI).
PJI undergoing 2-stage exchange, referred to the Department of Infectious Diseases of the Cotugno Hospital of Naples and the Fondazione Policlinico Gemelli of Rome over a 7-year period (2009-2015) for Infectious Diseases (ID) consultation were included. Demographic data, detailed information about previous or underlying diseases, findings of the clinical examination, and results of laboratory investigations were analyzed. The cure was defined by the disappearance of clinical, laboratory, and radiological evidence of PJI 96 week after the discontinuation of antibiotic treatment.
Thirty-one cases of PJI sustained by Enterococci were included (16 early infections, 13 delayed infections, and 2 late infections). Median age was 73 years (range 39-83), 39% were males. Comorbidities related to an increased risk of infection were reported in 17 (55%) cases. Joint pain interfering with daily living was reported in 27 (87%) cases, fever in 7 with early infection and in no case with delayed or late infection (7/17 vs. 0/14, Odds ratio undefined, p=0.01). Local inflammation and joint effusion were reported in 29 (93%) cases, sinus tract in 25 (81%). Enterococcus faecalis was the etiologic agent in 28 (90%) cases, E. faecium in 2 (6%), E. casseliflavus in 1 (3%). Eleven cases were polymicrobial. Favourable outcome was reported in 20 (65%) cases. Patients with comorbidities reported more frequently an unfavourable outcome (9/17 vs. 2/14, Odds ratio 6.7, 95% CI 1.1-39.8; p=0.06).
Comorbidities should arise the suspect of infection by enterococci. Associative protocols, considering drugs active against biofilm should be considered in the cases with enterococcal infection.
定植于肠道或泌尿道的病原体，如肠球菌或革兰氏阴性杆菌，可能导致人工关节感染（PJI）。
本研究纳入了 2009 年至 2015 年期间因感染性疾病（ID）咨询而转诊至那不勒斯科托诺医院传染病科和罗马杰梅利综合医院的 31 例 2 期关节置换术治疗的 PJI 患者。分析了患者的人口统计学数据、详细的既往或基础疾病信息、临床检查结果以及实验室检查结果。治愈定义为在停止抗生素治疗后 96 周时，临床、实验室和影像学 PJI 证据消失。
31 例 PJI 由肠球菌引起（16 例早期感染，13 例延迟感染，2 例晚期感染）。中位年龄为 73 岁（范围 39-83 岁），39%为男性。17 例（55%）患者存在与感染风险增加相关的合并症。27 例（87%）患者报告关节疼痛影响日常生活，7 例（7/17）有发热，而延迟或晚期感染均无发热（7/17 与 0/14，比值比未定义，p=0.01）。29 例（93%）患者报告局部炎症和关节积液，25 例（81%）患者报告窦道。28 例（90%）患者的病原体为粪肠球菌，2 例（6%）为屎肠球菌，1 例（3%）为鹑鸡肠球菌。11 例为混合感染。20 例（65%）患者的预后良好。有合并症的患者更常报告预后不良（9/17 与 2/14，比值比 6.7，95%可信区间 1.1-39.8；p=0.06）。
应怀疑合并症患者感染肠球菌。对于肠球菌感染，应考虑使用针对生物膜的联合方案。
