Rothman Orthopaedic Institute, Philadelphia, PA; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
Rothman Orthopaedic Institute, Philadelphia, PA.
J Arthroplasty. 2020 Mar;35(3):849-854. doi: 10.1016/j.arth.2019.09.044. Epub 2019 Oct 1.
While the prevailing belief is that periprosthetic joint infection (PJI) caused by Gram-negative (GN) organisms confers a poorer prognosis than Gram-positive (GP) cases, the current literature is sparse and inconsistent. The purpose of this study is to compare the treatment outcomes for GN PJI vs GP PJI and Gram-mixed (GM) PJI.
A retrospective review of 1189 PJI cases between 2007 and 2017 was performed using our institutional PJI database. Treatment failure defined by international consensus criteria was compared between PJI caused by GN organisms (n = 45), GP organisms (n = 663), and GM (n = 28) cases. Multivariate regression was used to predict time to failure.
GM status, but not GN, had significantly higher rates of treatment failure compared to GP PJI (67.9% vs 33.2% failure; hazards ratio [HR] = 2.243, P = .004) in the multivariate analysis. In a subanalysis of only the 2-stage exchange procedures, both GN and GM cases were significantly less likely to reach reimplantation than GP cases (HR = .344, P < .0001; HR = .404, P = .013).
Although there was no observed difference in the overall international consensus failure rates between GN (31.1% failure) and GP (33.2%) PJI cases, there was significant attrition in the 2-stage exchange GN cohort, and these patients were significantly less likely to reach reimplantation. Our findings corroborate the prevailing notion that GN PJI is associated with poorer overall outcomes vs GP PJI. These data add to the current body of literature, which may currently underestimate the overall failure rates of GN PJI treated via 2-stage exchange and fail to identify pre-reimplantation morbidity.
虽然普遍认为革兰氏阴性（GN）菌引起的人工关节周围感染（PJI）比革兰氏阳性（GP）菌引起的 PJI 预后更差，但目前的文献稀少且不一致。本研究旨在比较 GN PJI 与 GP PJI 和革兰氏混合（GM）PJI 的治疗结果。
使用我们的机构 PJI 数据库对 2007 年至 2017 年间的 1189 例 PJI 病例进行回顾性研究。采用国际共识标准定义的治疗失败，比较 GN 菌（n=45）、GP 菌（n=663）和 GM 菌（n=28）引起的 PJI 之间的治疗失败率。采用多变量回归预测失败时间。
GM 状态，而不是 GN，在多变量分析中，与 GP PJI 相比，治疗失败率显著更高（67.9%与 33.2%失败；危险比[HR]为 2.243，P=0.004）。在仅 2 期置换手术的亚分析中，GN 和 GM 病例与 GP 病例相比，达到再植入的可能性明显降低（HR=0.344，P<0.0001；HR=0.404，P=0.013）。
尽管 GN（31.1%失败）和 GP（33.2%）PJI 病例的总体国际共识失败率无观察差异，但 2 期置换 GN 组的病例明显减少，这些患者再植入的可能性明显降低。我们的发现证实了这样一种观点，即 GN PJI 与 GP PJI 相比，总体预后较差。这些数据增加了目前的文献，这可能会低估通过 2 期置换治疗的 GN PJI 的总体失败率，并未能确定再植入前的发病率。
