OrthoCarolina Research Institute, Charlotte, NC.
Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC.
J Arthroplasty. 2022 Jul;37(7S):S653-S656. doi: 10.1016/j.arth.2022.03.016. Epub 2022 Mar 11.
Open wound management in prosthetic joint infection (PJI) patients has been used in problematic dehisced wounds hoping to stimulate granulation tissue and closure. However, infections that start as a monomicrobial PJI can become polymicrobial with resultant worse outcomes following open wound management. This study assessed the relationship between open wound management and the development of polymicrobial periprosthetic joint infections.
We reviewed patients referred with a synovial cutaneous fistula. Patients with an open wound measuring less than 2 cm and less than two weeks of open wound management were excluded. Variables included original organisms cultured, type and length of open wound management, and organisms cultured at the time of revision infection surgery.
Of the 65 patients with a previous monomicrobial infection treated with open wound management, 22/65 (34%) progressed to a polymicrobial infection. Thirty (46%) wounds were packed open with gauze, 20 (31%) were managed with negative pressure wound therapy, and 15 (23%) had surface dressings only. Of the 22 patients who converted to a polymicrobial infection, only 10 (45%) were infection free at follow-up. In contrast, 30 of 43 patients (70%) whose infections remained monomicrobial were infection free at follow-up.
Open wound management can lead to conversion from a monomicrobial to a polymicrobial PJI, a rate of 34% in this series. Open prosthetic wound management should be discontinued for a fear of converting a monomicrobial infection to a difficult to treat polymicrobial infection. Surgeons must be prudent in the use of open wound management.
Level IV, Retrospective Case Series.
在患有假体关节感染（PJI）的患者中，开放性伤口管理已用于处理愈合不良的伤口，以期刺激肉芽组织并实现闭合。然而，最初为单一微生物 PJI 的感染可能会发展为多微生物感染，从而导致在接受开放性伤口管理后出现更差的结果。本研究评估了开放性伤口管理与多微生物假体关节周围感染发展之间的关系。
我们回顾了因滑膜皮肤瘘管而转诊的患者。排除了伤口小于 2 厘米且开放性伤口管理时间少于两周的患者。变量包括原始培养的微生物、开放性伤口管理的类型和长度以及在翻修感染手术时培养的微生物。
在 65 例接受开放性伤口管理的单一微生物感染患者中，22/65（34%）进展为多微生物感染。30 例（46%）伤口采用纱布敞开式包扎，20 例（31%）采用负压伤口治疗，15 例（23%）仅使用表面敷料。在 22 例转为多微生物感染的患者中，只有 10 例（45%）在随访时无感染。相比之下，30 例（70%）感染仍为单一微生物的患者在随访时无感染。
开放性伤口管理可导致从单一微生物 PJI 转变为多微生物 PJI，本研究系列中的发生率为 34%。对于单一微生物感染，应停止进行开放性假体伤口管理，以防止其转化为难治的多微生物感染。外科医生在使用开放性伤口管理时必须谨慎。
IV 级，回顾性病例系列。
