Enz Andreas, Mueller Silke C, Warnke Philipp, Ellenrieder Martin, Mittelmeier Wolfram, Klinder Annett
Orthopaedic Clinic and Policlinic, University Medicine Rostock, 18057 Rostock, Germany.
Institute of Pharmacology and Toxicology, University Medicine Rostock, 18057 Rostock, Germany.
J Fungi (Basel). 2021 May 21;7(6):404. doi: 10.3390/jof7060404.
The treatment of periprosthetic joint infections (PJI), and especially of re-infections, poses a highly complex problem in orthopaedic surgery. While fungal infections are rare, they present a special challenge. The therapy is often protracted and based on limited evidence. A total of 510 hip and knee revision surgeries were analysed for the occurrence of bacterial and fungal PJI. In patients with PJI, the duration of the hospital stay and the incidence of disarticulation of the infected joint were recorded. Out of the analysed revision arthroplasties, 43.5% were due to PJI. Monomicrobial infection occurred in 55.2%, dual microbial infection in 21.4%, and polymicrobial (≥3 different bacterial or fungal species) infection in 17.2% of the cases. Overall, were detected in 12.4% cases. was the main fungal pathogen. In 6.9% of cases, disarticulation of the joint was the only option to control PJI. The detection of polymicrobial infection more than doubled in follow-up revisions and there was a strong association between detection of infection and disarticulation (OR 9.39). The majority of fungal infections were mixed infections of bacteria and . The choice of a biofilm penetrating antimycotic, e.g., caspofungin, together with a sufficient standard procedure for detection and surgical treatment can help to control the infection situation. Fungal infection often proves to be more difficult to treat than anticipated and is more frequent than expected.
人工关节周围感染（PJI）的治疗，尤其是再感染的治疗，在骨科手术中是一个极其复杂的问题。虽然真菌感染很少见，但它们带来了特殊的挑战。治疗通常旷日持久且依据的证据有限。对总共510例髋膝关节翻修手术进行了细菌和真菌性PJI发生率的分析。记录了PJI患者的住院时间和感染关节离断的发生率。在分析的翻修关节成形术中，43.5%是由PJI引起的。55.2%的病例发生单一微生物感染，21.4%发生双重微生物感染，17.2%发生多重微生物（≥3种不同细菌或真菌种类）感染。总体而言，12.4%的病例检测到了[此处原文缺失具体内容]。[此处原文缺失具体内容]是主要的真菌病原体。在6.9%的病例中，关节离断是控制PJI的唯一选择。在随访翻修中，多重微生物感染的检测增加了一倍多，并且[此处原文缺失具体内容]感染的检测与关节离断之间存在很强的关联（比值比9.39）。大多数真菌感染是细菌和[此处原文缺失具体内容]的混合感染。选择一种能穿透生物膜的抗真菌药物，如卡泊芬净，以及足够的标准检测和手术治疗程序，有助于控制感染情况。真菌感染往往比预期更难治疗，且比预期更频繁。
