肠球菌性人工关节假体周围感染：8 年回顾性队列研究的临床和微生物学发现。
Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study.
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, Charitéplatz 1, 10117, Berlin, Germany.
Orthopaedic Hospital Valdoltra, SI-6280, Ankaran, Slovenia.
出版信息
BMC Infect Dis. 2019 Dec 27;19(1):1083. doi: 10.1186/s12879-019-4691-y.
BACKGROUND
Treatment of enterococcal periprosthetic joint infections (PJI) is challenging due to non-standardized management strategies and lack of biofilm-active antibiotics. The optimal surgical and antimicrobial therapy are unknown. Therefore, we evaluated characteristics and outcome of enterococcal PJI.
METHODS
Consecutive patients with enterococcal PJI from two specialized orthopedic institutions were retrospectively analyzed. Both institutions are following the same diagnostic and treatment concepts. The probability of relapse-free survival was estimated using Kaplan-Meier survival curves and compared by log-rank test. Treatment success was defined by absence of relapse or persistence of PJI due to enterococci or death related to enterococcal PJI. Clinical success was defined by the infection-free status, no subsequent surgical intervention for persistent or perioperative infection after re-implantation and no PJI-related death within 3 months.
RESULTS
Included were 75 enterococcal PJI episodes, involving 41 hip, 30 knee, 2 elbow and 2 shoulder prostheses. PJI occurred postoperatively in 61 episodes (81%), hematogenously in 13 (17%) and by contiguous spread in one. E. faecalis grew in 64 episodes, E. faecium in 10 and E. casseliflavus in one episode(s). Additional microorganism(s) were isolated in 38 patients (51%). Enterococci were susceptible to vancomycin in 73 of 75 isolates (97%), to daptomycin in all 75 isolates, and to fosfomycin in 21 of 22 isolates (96%). The outcome data was available for 66 patients (88%). The treatment success after 3 years was 83.7% (95% confidence interval [CI]; 76.1-96.7%) and the clinical success was 67.5% (95% CI; 57.3-80.8%). In 11 patients (17%), a new PJI episode caused by a different pathogen occurred. All failures occurred within 3 years after surgery.
CONCLUSION
About half of enterococcal PJI were polymicrobial infections. The treatment success was high (84%). All treatment failures occurred within the first 3 years after revision surgery. Interestingly, 17% of patients experienced a new PJI caused by another pathogen at a later stage.
TRIAL REGISTRATION
The study was retrospectively registered with the public clinical trial identification NCT0253022 at https://www.clinicaltrials.gov on 15 July 2015.
背景
由于缺乏针对生物膜的抗生素和非标准化的管理策略，肠球菌假体周围关节感染（PJI）的治疗极具挑战性。目前尚不清楚最佳的手术和抗菌治疗方法。因此，我们评估了肠球菌 PJI 的特征和结局。
方法
回顾性分析了来自两家专业骨科机构的连续肠球菌 PJI 患者。这两家机构遵循相同的诊断和治疗概念。使用 Kaplan-Meier 生存曲线估计无复发生存的概率，并通过对数秩检验进行比较。治疗成功定义为无复发或因肠球菌引起的 PJI 持续存在或因肠球菌 PJI 而死亡。临床成功定义为感染无复发、再植入后无持续性或围手术期感染且无 3 个月内与 PJI 相关的死亡。
结果
共纳入 75 例肠球菌 PJI 发作，涉及 41 例髋关节、30 例膝关节、2 例肘关节和 2 例肩关节假体。61 例（81%）为术后 PJI，13 例（17%）为血源性 PJI，1 例为相邻部位感染。64 例分离出屎肠球菌，10 例分离出产单核细胞李斯特菌，1 例分离出鹑鸡肠球菌。38 例患者（51%）还分离出其他微生物。75 株分离菌中，73 株（97%）对万古霉素敏感，全部 75 株对达托霉素敏感，22 株（96%）对磷霉素敏感。66 例患者（88%）可获得治疗后 3 年的数据。3 年后的治疗成功率为 83.7%（95%置信区间[CI]：76.1%-96.7%），临床成功率为 67.5%（95%CI：57.3%-80.8%）。11 例（17%）患者发生了另一种病原体引起的新的 PJI 感染。所有治疗失败均发生在术后 3 年内。
结论
约一半的肠球菌 PJI 为混合感染。治疗成功率较高（84%）。所有治疗失败均发生在翻修手术后的前 3 年内。有趣的是，17%的患者在后期出现了另一种病原体引起的新的 PJI。
临床试验注册
本研究于 2015 年 7 月 15 日在 https://www.clinicaltrials.gov 上以公开临床试验标识 NCT0253022 进行了回顾性注册。
Zotero 插件