长期抗菌抑制可预防链球菌性假体周围关节感染的治疗失败。
Long-term antimicrobial suppression prevents treatment failure of streptococcal periprosthetic joint infection.
机构信息
Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10117 Berlin, Germany.
Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, D-10117 Berlin, Germany.
出版信息
J Infect. 2019 Sep;79(3):236-244. doi: 10.1016/j.jinf.2019.06.015. Epub 2019 Jul 13.
OBJECTIVES
To evaluate the effect of oral antimicrobial suppression on the outcome of streptococcal periprosthetic joint infection (PJI).
METHODS
Consecutive patients with streptococcal PJI receiving antimicrobial suppression for >6 months were prospectively included and compared to a retrospective control group without suppression. Outcome was assessed with Kaplan-Meier analysis and compared by the log-rank Mantel-Cox test. Multivariate analysis was used to identify factors associated with treatment failure.
RESULTS
Of 69 streptococcal PJI episodes (37 knee, 31 hip and one shoulder PJI), 43 (62%) were caused by beta-hemolytic streptococci and 26 (38%) by viridans group streptococci. Debridement and prosthesis retention was performed in 27 (39%), one-stage exchange in 5 (7%), multi-stage exchange in 31 (44%) and prosthesis removal in 6 patients (9%). 24 patients (35%) were treated with antimicrobial suppression receiving oral amoxicillin (n = 22), doxycycline (n = 1) or clindamycin (n = 1). After a median follow-up of 13 months (range, 0.5-111 months), 38 of 65 patients (58%) were infection-free. Suppressive antimicrobial treatment was associated with higher success rate compared with no suppression (93% vs. 57%, p = 0.002), representing the only significant independent factor preventing treatment failure.
CONCLUSIONS
Long-term antimicrobial suppression was associated with significantly better treatment outcome and should be strongly considered in streptococcal PJI.
目的
评估口服抗菌药物抑制疗法对链球菌假体周围关节感染（PJI）转归的影响。
方法
前瞻性纳入了连续接受 >6 个月抗菌药物抑制疗法的链球菌 PJI 患者，并与未接受抑制疗法的回顾性对照组进行比较。采用 Kaplan-Meier 分析评估结局，并采用对数秩 Mantel-Cox 检验进行比较。采用多变量分析确定与治疗失败相关的因素。
结果
69 例链球菌 PJI 发作（37 例膝关节、31 例髋关节和 1 例肩关节 PJI）中，43 例（62%）由β-溶血性链球菌引起，26 例（38%）由草绿色链球菌引起。清创和保留假体分别在 27 例（39%）、1 例（1%）、5 例（7%）和 6 例（9%）中实施，1 期置换术在 5 例（7%）、多期置换术在 31 例（44%）中实施。24 例（35%）患者接受了抗菌药物抑制治疗，其中 22 例接受阿莫西林治疗，1 例接受多西环素治疗，1 例接受克林霉素治疗。中位随访 13 个月（0.5-111 个月）后，65 例患者中有 38 例（58%）无感染。与未抑制组相比，抑制组的治疗成功率更高（93% vs. 57%，p=0.002），这是唯一显著的独立预防治疗失败的因素。
结论
长期抗菌药物抑制疗法与更好的治疗结局显著相关，在链球菌 PJI 中应强烈考虑。
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