Zhou L C, Li G Q, Xu B Y, Mamtimin Asihaerjiang, Cao L, Zhang X G
Department of Arthroplasty,the First Affiliated Hospital,Xinjiang Medical University,Urumqi 830054,China.
Zhonghua Wai Ke Za Zhi. 2021 Jun 1;59(6):484-490. doi: 10.3760/cma.j.cn112139-20201224-00883.
To analyze the pathogen distribution and drug resistance in acute,delayed and chronic periprosthetic joint infection (PJI). The clinical data of 316 patients with periprosthetic infection after primary hip and knee arthroplasty admitted to the Department of Arthroplasty,the First Affiliated Hospital,Xinjiang Medical University from August 2010 to August 2020 were retrospectively analyzed.There were 146 males and 170 females,aged (62.3±14.2) years (range:22 to 89 years).One hundred and sixty one patients underwent total hip arthroplasty and 155 patients underwent total knee arthroplasty.According to the time of postoperative infection,the patients were divided into acute PJI group (65 cases),delayed PJI group (83 cases) and chronic PJI group (168 cases).The results of pathogen species,composition ratio and drug susceptibility tests were collected,and the independent sample test,Chi-square test or Fisher's exact probability test were used for comparison. Gram-positive bacteria were the main pathogens of PJI (49.7%,157/316),and the positive rates of culture in patients with acute PJI,delayed PJI and chronic PJI were 33.8% (22/65),55.4% (46/83) and 53.0% (89/168),and the difference was statistically significant(χ²=8.343,=0.015).The common bacteria were coagulase-negative Staphylococcus (54.8%,86/157) and Staphylococcus aureus (30.6%,48/157),The drug-sensitivity to linezolid,vancomycin and tigacycline was 100%.The gram-negative bacteria were mainly Escherichia coli and Enterobacter cloacae,and the drug resistance rate to carbapenems was low,ranging from 0 to 9.09%.The drug resistance rates of acute PJI patients to rifampicin,ciprofloxacin and erythromycin were significantly higher than those of late onset and chronic PJI patients,the difference was statistically significant(rifampicin:χ²=14.332,=0.001;ciprofloxacin:χ²=12.086,=0.002;erythromycin:χ²=9.096,=0.010);The drug resistance rate of acute PJI patients to levofloxacin,clindamycin and tetracycline was higher than that of chronic PJI patients,and the difference was statistically significant(levofloxacin:χ²=10.500,=0.002; clindamycin: χ²=7.103,=0.007; tetracycline: χ²=6.909, =0.012).The resistance rate of ampicillin/sulbactam in acute PJI (60.0%) was significantly higher than that in chronic PJI (16.7%),and the difference was statistically significant(χ²= 5.853,=0.040). Gram-positive bacteria are the main pathogens of PJI,and the resistance rate of pathogens of acute PJI is higher than that of late onset and chronic PJI.
分析急性、亚急性和慢性人工关节周围感染（PJI）的病原体分布及耐药情况。回顾性分析2010年8月至2020年8月新疆医科大学第一附属医院关节外科收治的316例初次髋、膝关节置换术后人工关节周围感染患者的临床资料。其中男性146例，女性170例，年龄（62.3±14.2）岁（范围：22至89岁）。161例行全髋关节置换术，155例行全膝关节置换术。根据术后感染时间，将患者分为急性PJI组（65例）、亚急性PJI组（83例）和慢性PJI组（168例）。收集病原体种类、构成比及药敏试验结果，采用独立样本t检验、卡方检验或Fisher确切概率法进行比较。革兰阳性菌是PJI的主要病原体（49.7%，157/316），急性PJI、亚急性PJI和慢性PJI患者的培养阳性率分别为33.8%（22/65）、55.4%（46/83）和53.0%（89/168），差异有统计学意义（χ²=8.343，P=0.015）。常见细菌为凝固酶阴性葡萄球菌（54.8%，86/157）和金黄色葡萄球菌（30.6%，48/157），对利奈唑胺、万古霉素和替加环素的药敏率为100%。革兰阴性菌主要为大肠埃希菌和阴沟肠杆菌，对碳青霉烯类的耐药率较低，为0至9.09%。急性PJI患者对利福平、环丙沙星和红霉素的耐药率显著高于迟发性和慢性PJI患者，差异有统计学意义（利福平：χ²=14.332，P=0.001；环丙沙星：χ²=12.086，P=0.002；红霉素：χ²=9.096，P=0.010）；急性PJI患者对左氧氟沙星、克林霉素和四环素的耐药率高于慢性PJI患者，差异有统计学意义（左氧氟沙星：χ²=10.500，P=0.002；克林霉素：χ²=7.103，P=0.007；四环素：χ²=6.909，P= .012）。急性PJI患者氨苄西林/舒巴坦的耐药率（60.0%）显著高于慢性PJI患者（16.7%），差异有统计学意义（χ²=5.853，P=0.040）。革兰阳性菌是PJI的主要病原体，急性PJI病原体的耐药率高于迟发性和慢性PJI。
