肝硬化患者中肠细菌导致假体周围关节感染的发生率增加。
Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis.
机构信息
Department of Internal Medicine I, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany.
出版信息
BMC Infect Dis. 2022 Apr 19;22(1):389. doi: 10.1186/s12879-022-07379-2.
INTRODUCTION
Periprosthetic joint infections (PJI) are a major complication in joint-arthroplasty. Rifampicin is often used as an additional agent to treat PJI, because it penetrates bacterial biofilms. However, rifaximin, belonging to the same antibiotic class as rifampicin, is frequently used to prevent episodes of hepatic encephalopathy in patients with cirrhosis and may induce resistance to rifampicin. The aim of this study was to examine the microbial pattern of periprosthetic joint infections in cirrhotic patients and to test the hypothesis that intake of rifaximin increases the rate of resistance to rifampicin in periprosthetic joint infections.
METHODS
A cohort of cirrhotic patients and PJI (n = 25) was analysed on the characteristics of bacterial isolates from sonication and tissue analysis. In a second step a subgroup analysis on the development of rifampicin resistant bacterial specimens, depending on the intake of rifaximin (8 rifaximin intake patients vs. 13 non rifaximin intake patients) was performed.
RESULTS
Intestinal bacteria were found in 50% of the specimens, which was significantly more frequent than in a control cohort. By comparison of the single bacterial isolates, rifampicin resistance was detected in 69.2% (9/13) of the rifaximin-intake samples. In contrast, the non-rifaximin-intake isolates only were resistant to rifampicin in 22.2% (4/18) of the cases (p = 0.01). The odds ratio for developing a rifampicin-resistance through rifaximin intake was calculated as OR = 13.5.
CONCLUSION
Periprosthetic joint infections have a high incidence of being caused by enteric bacteria in cirrhotic patients. Due to this change in microbial pattern and the innate resistance to rifampicin of most of gram-negative bacteria, the therapy with rifampicin should be carefully considered. The association between the use of rifaximin and developed resistance to rifampicin has a major impact on the treatment of PJI.
引言
人工关节置换术后感染（PJI）是关节置换术的主要并发症。利福平常被用作治疗 PJI 的附加药物，因为它能穿透细菌生物膜。然而，利福昔明属于与利福平相同的抗生素类别，常被用于预防肝硬化患者肝性脑病发作，并且可能诱导利福平耐药。本研究旨在研究肝硬化患者人工关节假体周围感染的微生物模式，并检验利福昔明摄入增加人工关节假体周围感染利福平耐药率的假设。
方法
对 25 例肝硬化合并 PJI 患者的超声检查和组织分析中的细菌分离株特征进行了分析。在第二步中，根据利福昔明的摄入情况（8 例利福昔明摄入患者和 13 例非利福昔明摄入患者），对利福平耐药细菌标本的发展进行了亚组分析。
结果
50%的标本中发现了肠道细菌，这明显比对照队列更常见。通过比较单一的细菌分离株，在 13 例利福昔明摄入样本中，有 69.2%（9/13）检测到利福平耐药。相比之下，在 18 例非利福昔明摄入样本中，只有 22.2%（4/18）的样本对利福平耐药（p=0.01）。利福昔明摄入导致利福平耐药的比值比计算为 OR=13.5。
结论
在肝硬化患者中，人工关节假体周围感染的发病率很高，由肠道细菌引起。由于微生物模式的这种变化，以及大多数革兰氏阴性菌对利福平的固有耐药性，利福平的治疗应慎重考虑。利福昔明的使用与利福平耐药的发展之间的关联对 PJI 的治疗有重大影响。
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