Department of Orhopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany.
Division of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium.
J Arthroplasty. 2022 Feb;37(2):373-378. doi: 10.1016/j.arth.2021.10.020. Epub 2021 Nov 3.
The microbiological implications of septic failure after 1-stage exchange for prosthetic joint infection (PJI) of the hip remain unclear.
Information was gathered on comorbidities, previous procedures, preoperative and postoperative microbiology results, methods of detection, and antibiotic resistance patterns, for all patients, who developed septic failure after 1-stage exchange for PJI of the hip performed at our institution during 2001-2017.
Seventy-seven patients were identified. Septic failure was diagnosed a mean of 1.7 (standard deviation 2.3, range 0-11.8) years later. Although the spectrum of microorganisms was similar to preoperative, in the majority of patients (55%), the initial microorganism(s) was (were) replaced by (a) totally different microorganism(s). Overall, there was a decrease in the number of polymicrobial PJIs. The number of patients with high virulent microorganisms decreased significantly from 52 to 36 (P = .034). The number of PJIs due to gram-negative pathogens remained similar (11 vs 14, P = .491). The number of rifampicin-resistant staphylococci, fluoroquinolone-resistant streptococci, enterococci, and fungi changed from 8 to 15, 0 to 2, 7 to 3, and 1 to 2, respectively, but these changes did not reach statistical significance.
The majority of reinfections is caused by different infecting bacteria, hence it is essential to perform a new diagnostic workup and not base treatment decisions (solely) on historical cultures. We were furthermore unable to irrefutably prove that, from a microbiological point of view, septic failure after 1-stage exchange comes with increased challenges. Given the time interval to failure, we propose that a longer follow-up of these patients is needed, than previously suggested.
髋关节一期翻修治疗假体关节感染（PJI）后发生败血症失败的微生物学意义尚不清楚。
收集了 2001-2017 年在我院行髋关节一期翻修治疗 PJI 后发生败血症失败的所有患者的合并症、既往手术、术前和术后微生物学结果、检测方法和抗生素耐药模式等信息。
共确定了 77 例患者。败血症失败的平均诊断时间为 1.7 年（标准差 2.3 年，范围 0-11.8 年）。尽管微生物群谱与术前相似，但在大多数患者（55%）中，最初的微生物（s）被（a）完全不同的微生物（s）取代。总的来说，多微生物 PJI 的数量减少了。高毒力微生物的患者数量从 52 例显著减少至 36 例（P =.034）。革兰氏阴性病原体引起的 PJI 数量保持不变（11 例比 14 例，P =.491）。耐利福平的葡萄球菌、氟喹诺酮耐药链球菌、肠球菌和真菌的数量分别从 8 例增加至 15 例、0 例增加至 2 例、7 例增加至 3 例和 1 例增加至 2 例，但这些变化没有统计学意义。
大多数再感染是由不同的感染细菌引起的，因此必须进行新的诊断性检查，而不能仅基于历史培养物来做出治疗决策。此外，我们无法无可争议地证明，从微生物学角度来看，一期翻修后发生败血症失败会带来更大的挑战。鉴于失败的时间间隔，我们建议需要对这些患者进行更长时间的随访，比之前建议的时间更长。
