Akkaya Mustafa, Vles Georges, Bakhtiari Iman Godarzi, Sandiford Amir, Salber Jochen, Gehrke Thorsten, Citak Mustafa
Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.
Int Orthop. 2022 Apr;46(4):687-695. doi: 10.1007/s00264-021-05291-z. Epub 2022 Jan 4.
Re-operation after septic failure of a one-stage exchange for prosthetic joint infection (PJI) of the knee is a highly challenging procedure with concerns over residual bone stock, soft tissues, and stability. The associated changes in microbiology in cases of reinfection are still largely unknown.
A comprehensive analysis was performed of all patients treated at our tertiary institution between 2001 and 2017 who developed reinfection after a one-stage exchange for PJI of the knee. Prerequisites for inclusion were a certain diagnosis of PJI according to the ICM criteria and a minimum follow-up of three years. Data on comorbidities, previous surgical interventions, microbiological findings at the time of the initial one-stage exchange and at the time of reinfection, detection methods, and antibiotic resistance patterns were retrospectively studied.
Sixty-six patients were identified that met the inclusion criteria. Reinfection occurred after a mean time interval of 27.7 months (SD ± 33.9, range 1-165). Ten types of bacteria were found that were not present before the one-stage exchange. The causative pathogen remained identical in 22 patients (33%) and additional microorganisms were detected in ten patients (15%). Half of the reinfections were however due to (a) completely different microorganism(s). A significant increase in the number of PJIs on the basis of high-virulent (23 vs 30, p = 0.017) and difficult-to-treat bacteria (13 vs 24, p = 0.035) was found.
The present study provides a novel insight into the microbiological changes following septic failure after one-stage exchange for PJI of the knee. A higher prevalence of more difficult-to-treat bacteria might increase the complexity of subsequent procedures. Also, a longer follow-up of these patients than previously suggested seems in order.
膝关节假体周围感染（PJI）一期翻修术后因感染性失败而进行再次手术是一项极具挑战性的手术，需要考虑剩余骨量、软组织和稳定性。再次感染时微生物学的相关变化仍 largely 未知。
对 2001 年至 2017 年在我们三级医疗机构接受治疗且膝关节 PJI 一期翻修术后发生再次感染的所有患者进行了全面分析。纳入标准为根据 ICM 标准确诊为 PJI 且至少随访三年。回顾性研究了合并症、既往手术干预、初次一期翻修时和再次感染时的微生物学检查结果、检测方法以及抗生素耐药模式的数据。
确定了 66 例符合纳入标准的患者。再次感染发生的平均时间间隔为 27.7 个月（标准差±33.9，范围 1 - 165 个月）。发现了 10 种在一期翻修前不存在的细菌。22 例患者（33%）的致病病原体保持不变，10 例患者（15%）检测到额外的微生物。然而，一半的再次感染是由（一种）完全不同的微生物引起的。发现基于高毒力细菌（23 例对 30 例，p = 0.017）和难治性细菌（13 例对 24 例，p = 0.035）的 PJI 数量显著增加。
本研究为膝关节 PJI 一期翻修术后感染性失败后的微生物学变化提供了新的见解。更难治细菌的较高患病率可能会增加后续手术的复杂性。此外，对这些患者进行比先前建议更长时间的随访似乎是合适的。
