Orthopedics. 2020 Nov 1;43(6):345-350. doi: 10.3928/01477447-20200923-03. Epub 2020 Oct 1.
Staphylococcus lugdunensis has been increasingly recognized as a cause of serious infections, particularly prosthetic joint infections (PJIs). The aim of this study was to describe the clinical characteristics, treatments, and outcomes of S lugdunensis PJIs. This was a retrospective multicenter study of consecutive adult patients with S lugdunensis PJIs from January 2007 through December 2017; 28 patients met inclusion criteria. The knee was the most commonly affected joint (67.9%), followed by the hip (25%). Clinical and microbiologic characteristics, treatment modalities, and outcomes were evaluated. Thirteen (46.4%) patients had two-stage revision, 9 (32.1%) had debridement with or without revision, 5 (21.4%) had no surgical intervention, and 1 (3.6%) had one-stage revision. Twenty-four (85.7%) patients had monomicrobial infection with S lugdunensis, whereas 4 had polymicrobial. Two patients had concomitant bacteremia. All isolates, except 1, were susceptible to oxacillin. Three patients with no surgical intervention received oral antibiotics, 2 were not treated, and 1 was discharged to hospice. Relapse was observed in 2 of 13 (15%) patients who had two-stage revision, 4 of 9 (44%) who had debridement, and 6 of 6 (100%) who had no surgical intervention or one-stage revision regardless of antibiotic treatment regimen. There was a significant difference in cure rate for patients who underwent two-stage revision compared with other treatment modalities (85% vs 33%, P=.009). Appropriate management of S lugdunensis PJI includes both aggressive surgical treatment and a prolonged course of antibiotics and is associated with excellent clinical response. Regardless of route or duration of antibiotic therapy, relapse is high for patients not treated with two-stage revision. [Orthopedics. 2020;43(6):345-350.].
路邓葡萄球菌已被越来越多地认为是严重感染的原因，特别是人工关节感染（PJI）。本研究的目的是描述路邓葡萄球菌 PJI 的临床特征、治疗方法和结局。这是一项回顾性多中心研究，纳入了 2007 年 1 月至 2017 年 12 月期间连续的成人路邓葡萄球菌 PJI 患者；28 名患者符合纳入标准。膝关节是最常受影响的关节（67.9%），其次是髋关节（25%）。评估了临床和微生物学特征、治疗方式和结局。13 名（46.4%）患者接受了两阶段翻修，9 名（32.1%）患者进行了清创术，其中包括或不包括翻修，5 名（21.4%）患者未进行手术干预，1 名（3.6%）患者进行了一阶段翻修。24 名（85.7%）患者为路邓葡萄球菌单一致感染，4 名患者为混合感染。2 名患者伴有菌血症。除 1 例外，所有分离株均对苯唑西林敏感。3 名未接受手术干预的患者接受了口服抗生素治疗，2 名未接受治疗，1 名患者出院至临终关怀。在接受两阶段翻修的 13 名患者中有 2 名（15%）、接受清创术的 9 名患者中有 4 名（44%）、未接受手术干预或一阶段翻修的 6 名患者中有 6 名（100%）出现复发，无论采用何种抗生素治疗方案，差异均有统计学意义（P=.009）。与其他治疗方法相比，两阶段翻修的患者治愈率有显著差异（85%比 33%）。路邓葡萄球菌 PJI 的适当治疗包括积极的手术治疗和长期使用抗生素，可获得良好的临床反应。无论抗生素治疗途径或持续时间如何，未行两阶段翻修的患者复发率均较高。
