Department for Orthopaedics and Traumatology, Kepler University Hospital, Linz, Austria.
University Hospital Marburg, Marburg, Germany.
Bone Joint J. 2021 Jun;103-B(6 Supple A):171-176. doi: 10.1302/0301-620X.103B6.BJJ-2020-1923.R1.
The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown.
A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime.
We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent.
Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: 2021;103-B(6 Supple A):171-176.
全膝关节置换术后假体周围关节感染（PJI）的治疗具有挑战性。由于各国之间流行病学和耐药性的差异，以及文献中的报道，正确的抗生素管理仍然难以捉摸。在研究手术治疗的疗效之前，分析引起 PJI 的细菌菌株至关重要，特别是对于那些未培养出任何病原体的患者。
对 2006 年至 2018 年在一家三级转诊中心进行的所有翻修 TKA 进行了回顾性分析，包括所有符合 PJI 共识标准并确定病原体的患者。使用聚类分析，创建了三个时间序列。然后，我们评估了这三个时间序列中鉴定出的细菌的抗生素耐药性和我们的抗生素方案的有效性。
我们共发现 97 例患者 129 例 PJI 中有 161 例培养出细菌。凝固酶阴性葡萄球菌（CNS）在 46.6%的培养物中被发现，其次是金黄色葡萄球菌，占 19.8%。在研究期间，抗生素的总体耐药率没有显著增加（p = 0.454）。然而，CNS 对替考拉宁（p < 0.001）、磷霉素（p = 0.016）和四环素（p = 0.014）的耐药性显著增加。万古霉素的总敏感性为 84.4%，CNS 敏感性为 100%，是最有效的药物。
尽管我们未能在研究期间显示 TKA 后引起 PJI 的细菌的抗生素耐药性总体增加，但 CNS 并非如此。令人担忧的是，CNS 对新抗生素的耐药性（但不是万古霉素）在不到 10 年的时间里有所增加。我们的研究结果表明，转诊中心应持续监测其细菌分析，因为这对原发性关节置换术和 PJI 翻修术的预防性治疗有重要影响。引用本文：2021；103-B（6 增刊 A）：171-176。
