Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.
J Arthroplasty. 2021 Jun;36(6):2158-2164. doi: 10.1016/j.arth.2021.01.074. Epub 2021 Feb 2.
A positive microbiological result at reimplantation may lead to a failed 2-stage revision arthroplasty in the treatment of periprosthetic joint infections. Little is known about changes in microbiological spectrum and resistance pattern between culture positive first and second stage procedures in revision knee and hip arthroplasty.
Between January 2011 and December 2019, we performed 327 two-stage revision arthroplasties on 312 patients. There were 37 of 312 (11.9%) patients (20 hips/17 knees) who had a positive microbiological culture during the first and second stage procedure. We analyzed the microbiological spectrum, antimicrobial resistance pattern, and clinical outcome of culture positive first and second stage procedures as well as subsequent re-revisions.
Re-revision was necessary in 40.5% (15/37) of patients with culture positive first and second stage procedure at a median follow-up of 3.5 years. We found microbiological changes in 83.8% (31/37) of patients between the first and second stage and in 88.9% (8/9) between the second stage and subsequent culture positive re-revision. Polymicrobial infections were found in 21.6% (8/37) of first and in 16.2% (6/37) of second stage procedures. In 27% (10/37) of patients, microorganisms persisted between the first and second stage procedure. The antimicrobial resistance pattern changed in 60% of persistent microorganisms between the first and second stage procedure.
Changes in microbiological spectrum and resistance pattern are common between culture positive first and second stage procedures as well as subsequent re-revisions. This has to be considered in the antimicrobial treatment of periprosthetic joint infections.
在翻修术中，再植入时的阳性微生物结果可能导致 2 期翻修术失败。在膝关节和髋关节翻修术中，关于初次和再次阳性培养的微生物谱和耐药模式的变化知之甚少。
2011 年 1 月至 2019 年 12 月，我们对 312 名患者进行了 327 例 2 期翻修术。312 例患者中有 37 例（11.9%）（20 髋/17 膝）在初次和再次阶段均有阳性微生物培养。我们分析了初次和再次阳性培养的微生物谱、抗菌药物耐药模式和临床结果，以及随后的再翻修。
在初次和再次阳性培养的 37 例患者中，有 40.5%（15/37）在中位随访 3.5 年后需要再翻修。我们发现 83.8%（31/37）的患者在初次和 88.9%（8/9）的患者在再次之间存在微生物变化。初次阶段有 21.6%（8/37）的患者和再次阶段有 16.2%（6/37）的患者为混合感染。在 27%（10/37）的患者中，微生物在初次和再次之间持续存在。初次和再次之间的 60%的持续微生物的抗菌药物耐药模式发生了变化。
初次和再次阳性培养以及随后的再翻修之间，微生物谱和耐药模式的变化很常见。在治疗假体周围关节感染时应考虑到这一点。
