II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130, Vienna, Austria.
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, 1130, Vienna, Austria.
BMC Musculoskelet Disord. 2022 Jan 19;23(1):72. doi: 10.1186/s12891-022-05037-x.
In recent years, total hip arthroplasty via the direct anterior approach (DAA) has become more common. Little is known on the influence of the surgical approach on the microbiological spectrum and resistance pattern in periprosthetic hip joint infections. The aim of the present study was to evaluate the microbiological spectrum and resistance pattern in periprosthetic hip joint infections comparing the direct anterior versus lateral approach in a matched-cohort analysis at a single institution.
Patients who underwent revision hip arthroplasty due to PJI following primary total hip arthroplasty with culture positive microbiology were analyzed. In all study patients, both the primary surgery and the revisions surgery were performed at the same institution. Only patients in whom primary surgery was performed via a direct anterior or lateral approach were included (n = 87). A matched cohort analysis was performed to compare the microbiological spectrum and resistance pattern in PJI following direct anterior (n = 36) versus lateral (n = 36) primary THA.
We identified both a significantly different microbiological spectrum and resistance pattern in PJI comparing direct anterior versus lateral approach THA. Cutibacterium avidum was obtained more frequently in the anterior subgroup (22.2% vs. 2.8%, p = 0.028). In the subgroup of infections with Staphylococcus aureus (n = 12), methicillin resistance was detected in 3/5 cases in the direct anterior group versus 0/7 cases in the lateral group (p = 0.045). Overall, Staphylococcus epidermidis was the most common causative microorganism in both groups (direct anterior: 36.1%; lateral: 27.8%, p = 0.448).
The present study indicates a potential influence of the localization of the skin incision in THA on the microbiological spectrum and resistance pattern in PJI. Cutibacterium avidum seemed to be a more common causative microorganism in PJI in patients who underwent direct anterior compared to lateral approach THA.
近年来，经直接前侧入路（DAA）的全髋关节置换术越来越普遍。对于手术入路对人工髋关节置换术后感染的微生物谱和耐药模式的影响知之甚少。本研究旨在通过单中心匹配队列分析比较直接前侧入路与外侧入路，评估人工髋关节置换术后感染的微生物谱和耐药模式。
对因原发性全髋关节置换术后微生物培养阳性而接受翻修的髋关节感染患者进行分析。在所有研究患者中，初次手术和翻修手术均在同一机构进行。仅纳入初次手术采用直接前侧或外侧入路的患者（n=87）。进行匹配队列分析比较直接前侧（n=36）与外侧（n=36）初次 THA 后髋关节感染的微生物谱和耐药模式。
我们发现，直接前侧与外侧入路 THA 后髋关节感染的微生物谱和耐药模式存在显著差异。前侧亚组中更常分离出缓症痤疮丙酸杆菌（22.2% vs. 2.8%，p=0.028）。在金黄色葡萄球菌感染亚组（n=12）中，直接前侧组 3/5 例存在耐甲氧西林，而外侧组 0/7 例（p=0.045）。总体而言，表皮葡萄球菌是两组中最常见的病原体（直接前侧：36.1%；外侧：27.8%，p=0.448）。
本研究表明，THA 皮肤切口的位置可能对人工髋关节置换术后感染的微生物谱和耐药模式有影响。与外侧入路 THA 相比，直接前侧入路 THA 后髋关节感染患者中缓症痤疮丙酸杆菌似乎是更常见的病原体。
