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感染性关节炎的临床特征、致病病原体及革兰氏阴性菌感染的危险因素

Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections.

作者信息

Lee Yongseop, Cho Yun Suk, Sohn Yu Jin, Hyun Jong Hoon, Ahn Sang Min, Lee Woon Ji, Kim Jung Ho, Seong Hye, Kim Junhyoung, Jeong Su Jin, Ku Nam Su, Yeom Joon Sup, Ahn Jin Young, Choi Jun Yong

机构信息

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

AIDS research Institute, Yonsei University College of Medicine, Seoul, Korea.

出版信息

Infect Chemother. 2020 Dec;52(4):503-515. doi: 10.3947/ic.2020.52.4.503.

DOI:10.3947/ic.2020.52.4.503
PMID:33377320
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7779980/
Abstract

BACKGROUND

The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis.

MATERIALS AND METHODS

Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively.

RESULTS

A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were (51.1%), followed by sp. (21.1%), (8.4%), and coagulase-negative- (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections.

CONCLUSION

Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

摘要

背景

本研究旨在描述感染性关节炎的临床和微生物学特征，并分析导致感染性关节炎的革兰氏阴性菌感染的危险因素。

材料与方法

对2009年至2018年期间在一家三级医院住院的感染性关节炎患者进行回顾性评估。

结果

本研究共纳入181例患者。其中，135例为天然关节感染患者，46例为人工关节感染患者。感染性关节炎最常见的部位是膝关节（63.6%），其次是肩关节（17.7%）和髋关节（9.9%）。最常鉴定出的微生物是[未提及具体微生物名称1]（51.1%），其次是[未提及具体微生物名称2]菌属（21.1%）、[未提及具体微生物名称3]（8.4%）和凝固酶阴性葡萄球菌（CNS；8.4%）。革兰氏阴性菌和真菌引起的感染分别占所有病例的13.7%和3.2%。此外，20%和4.2%的病例涉及耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）。我们发现菌尿、髋关节感染性关节炎和入院时使用类固醇是革兰氏阴性菌感染的独立危险因素。

结论

在韩国的一家三级医院中，耐甲氧西林微生物引起的感染性关节炎高达约25%。对于疑似尿路感染、髋关节感染性关节炎或感染性关节炎患者入院时使用类固醇的情况，可考虑经验性治疗覆盖革兰氏阴性微生物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/7779980/e24b8a22954d/ic-52-503-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/7779980/d7c716572285/ic-52-503-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/7779980/e24b8a22954d/ic-52-503-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/7779980/d7c716572285/ic-52-503-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da7c/7779980/e24b8a22954d/ic-52-503-g002.jpg

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