Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Boston University School of Medicine, Boston, Massachusetts, USA.
Surg Infect (Larchmt). 2021 Oct;22(8):828-835. doi: 10.1089/sur.2020.302. Epub 2021 Mar 9.
Peri-prosthetic joint infection (PJI) is a debilitating and costly complication of joint replacement. Synovial fluid cultures are negative in up to 25% of PJI cases. The purpose of this study was to compare the clinical characteristics and outcomes of culture negative and culture positive PJI. We conducted a retrospective study including all patients aged 18 and older admitted to a single tertiary-care hospital between 1998 and 2015 diagnosed with PJI and treated with antibiotic agents and surgery. One hundred ninety-six patients with PJI were identified; 48 (24.5%) were culture-negative (CN) and 148 (75.5%) were culture-positive (CP). The groups were similar in age and presence of associated comorbidities. Fever was more common among the CP patients (CN, 23.8%; CP, 38.4%; p = 0.03) as was sepsis defined by Sepsis-2 criteria (CN, 12.8%; CP, 28.7%; p = 0.03). Patients who were CP had higher synovial white blood cell (WBC) count (CN, 30,500 per milliliter; CP, 95,400 per milliliter; p < 0.01), a longer length of stay (CN, 3.8%; CP,7.9%; p = 0.02), and fewer alternative diagnoses established within one year (CN, 25.0%; CP, 2.7%; p < 0.01). Our logistic regression models also found that CP patients had an adjusted odds ratio (OR) of 2.59 for rehabilitation placement with 95% confidence interval (CI) of 1.15-5.83 and adjusted OR of 0.04 for an alternative diagnosis within one year with 95% CI, 0.009-0.22 compared with their CN counterparts. This study suggests that patients with CN PJI have less severe disease, better outcomes, and higher rates of alternative diagnoses within one year.
假体周围关节感染（PJI）是关节置换的一种使人虚弱且代价高昂的并发症。在多达 25%的 PJI 病例中，滑液培养结果为阴性。本研究旨在比较培养阴性和培养阳性 PJI 的临床特征和结局。
我们进行了一项回顾性研究，纳入了 1998 年至 2015 年期间在一家三级保健医院住院且接受抗生素和手术治疗的所有年龄在 18 岁及以上的 PJI 患者。共确定了 196 例 PJI 患者，其中 48 例（24.5%）为培养阴性（CN），148 例（75.5%）为培养阳性（CP）。两组患者的年龄和并存的合并症相似。CP 患者更常见发热（CN，23.8%；CP，38.4%；p=0.03），符合 Sepsis-2 标准的败血症（CN，12.8%；CP，28.7%；p=0.03）也更常见。CP 患者的滑膜白细胞（WBC）计数更高（CN，30500 个/毫升；CP，95400 个/毫升；p<0.01），住院时间更长（CN，3.8%；CP，7.9%；p=0.02），一年内确定的其他诊断更少（CN，25.0%；CP，2.7%；p<0.01）。我们的逻辑回归模型还发现，CP 患者的康复安置调整比值比（OR）为 2.59，95%置信区间（CI）为 1.15-5.83，一年内其他诊断的调整 OR 为 0.04，95%CI 为 0.009-0.22，与 CN 患者相比。
本研究表明，CN PJI 患者的疾病严重程度较轻，结局较好，且一年内其他诊断的发生率较高。
