Manning Laurens, Metcalf Sarah, Clark Benjamin, Robinson James Owen, Huggan Paul, Luey Chris, McBride Stephen, Aboltins Craig, Nelson Renjy, Campbell David, Solomon Lucian Bogdan, Schneider Kellie, Loewenthal Mark, Yates Piers, Athan Eugene, Cooper Darcie, Rad Babak, Allworth Tony, Reid Alistair, Read Kerry, Leung Peter, Sud Archana, Nagendra Vana, Chean Roy, Lemoh Chris, Mutalima Nora, Grimwade Kate, Sehu Marjorie, Torda Adrienne, Aung Thi, Graves Steven, Paterson David, Davis Josh
Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia.
Medical School, University Western Australia, Perth, WA, Australia.
Open Forum Infect Dis. 2020 May 14;7(5):ofaa068. doi: 10.1093/ofid/ofaa068. eCollection 2020 May.
Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections.
The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation.
We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%).
In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials.
人工关节周围感染（PJI）是关节置换手术的一种严重并发症。大多数关于PJI的观察性研究都是回顾性的或单中心的，所报道的管理方法和结果差异很大。我们假设PJI管理存在显著异质性，并且大多数PJI会表现为因血流感染导致的晚期急性感染。
澳大利亚和新西兰人工关节感染观察性（PIANO）研究是一项在27家医院进行的前瞻性研究。从2014年7月至2017年12月，我们纳入了所有新诊断为大关节PJI的成年人。我们收集了患者就诊后头3个月的人口统计学、微生物学以及手术和抗生素管理方面的数据。
我们纳入了783例患者（427例膝关节、323例髋关节、25例肩关节、6例肘关节和2例踝关节）。感染表现方式以晚期急性为主（植入后>30天且症状<7天；351例，占45%），其次是早期（植入后≤30天；196例，占25%）和慢性（植入后>30天且症状≥30天；148例，占19%）。清创、抗生素、冲洗和保留植入物是最常见的初始管理方法（565例，占72%），但142例（占25%）的清创程度为中等或更低，104例（占23%）未更换聚乙烯衬垫。
与大多数研究不同，晚期急性感染是最常见的表现方式，这可能反映了血行播散。管理方式存在异质性，这反映了证据基础薄弱以及需要进行随机对照试验。
